Anon

Stresses of battle hit female GIs hard

Sun Mar 20, 9:40 AM ET

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By Kirsten Scharnberg Tribune national correspondent

On a mission just south of Baghdad over the winter, a young soldier jumped into the gunner's turret of an armored Humvee and took control of the menacing .50-caliber machine gun. She was 19 years old, weighed barely 100 pounds and had a blond ponytail hanging out from under her Kevlar helmet.

"This is what is different about this war," Lt. Col. Richard Rael, commander of the 515th Corps Support Battalion, said of the scene at the time. "Women are fighting it. Women under my command have confirmed kills. These little wisps of things are stronger than anyone could ever imagine and taking on more than most Americans could ever know."

But today, two years after the start of an Iraq (news - web sites) war in which traditional front lines were virtually obliterated and women were tasked to fill lethal combat roles more routinely than in any conflict in U.S. history, the nation may be just beginning to see and feel the effects of such service.

Thousands of women, like the male veterans of so many wars before, are returning home emotionally damaged by what they have seen and done. These female troops appear more prone to post-traumatic stress disorder, or PTSD, than their male counterparts.

And studies indicate that many of these women suffer from more pronounced and debilitating forms of PTSD than men, a worrisome finding in a nation that remembers how many traumatized troops got back from Vietnam and turned to drugs and violence, alcohol and suicide.

One children's book increasingly popular among military families illustrates what the effects of this most recent war might mean for society in the years and even decades to come: "Why Is Mommy Like She Is? A Book for Kids About PTSD."(EDIT: Retch)

In the wake of such concerns, the Veterans Affairs Department has launched a pioneering $6 million study of PTSD among female veterans. It is the first VA study to focus exclusively on female veterans; 8 percent to 10 percent of active-duty and retired military women suffer from PTSD.

"PTSD is a very real problem for women who serve in the military," said Paula Schnurr, one of the study's lead researchers and the deputy executive director of the VA's National Center for PTSD in White River Junction, Vt. "This study is specifically addressing that, and we hope it will not only help us treat women coming home from Iraq, but all those who have ever served and struggled with PTSD in any conflict before."

The study's findings are not due until the end of the year, but researchers already have made some startling discoveries that are illustrative of the nature of PTSD among female veterans and of the U.S. military.

According to Schnurr, data indicate that female military personnel are far more likely than their male counterparts to have been exposed to some kind of trauma or multiple traumas before joining the military or being deployed in combat. That may include physical assault, sexual abuse or rape.

"The speculation is that many of them are joining the military to get away from adverse environments," said Schnurr, also a professor of psychiatry at Dartmouth College, speaking of the nearly 216,000 U.S. women on active duty and the nearly 151,000 who are part of the reserves and National Guard.

The implication of such a finding on PTSD research is considered significant. Because most research indicates that a person is at greater risk of developing PTSD--or developing more severe PTSD--when he or she has had past traumas, many female troops are deploying to war zones already heavily predisposed to react adversely to the intense fear, killing and loss routinely encountered there.


"The evidence is conclusive," said Rachel MacNair, an expert in the psychological effects of violence and PTSD. "The greater the trauma in your life, the greater the symptoms of PTSD."

MacNair, however, focuses on another factor that she believes more acutely affects the rate of PTSD among veterans of Iraq: whether they have killed during their deployment.

In 1999, MacNair earned her doctorate at the University of Missouri-Kansas City with a study that analyzed the data from the National Vietnam Veterans Readjustment Study, a landmark congressionally funded project that studied nearly 1,700 veterans.

Her findings were stark: Troops who had killed--or believed they had killed--suffered significantly higher rates of PTSD than those who had not.

"It is very clear that being shot at is traumatic, or losing your buddy is traumatic, but the act of shooting and killing another human being, something that goes against every instinct we have, is the biggest trauma of all," said MacNair, who calls this kind of PTSD "perpetration-induced traumatic stress."

That hypothesis by MacNair, who is strongly critical of the military, is supported by history and by military experts.

S.L.A. Marshall, one of the earlier official Army historians, estimated after studying World War II veterans that only 15 percent had fired their weapons during battle. He asserted from his interviews with soldiers that their failure in battle was because they were more afraid of killing than of being killed. Other studies show that even the most poorly treated prisoners of war had lower rates of PTSD than front-line soldiers because the prisoners no longer were in a position where they had to kill.

How such findings translate to the Iraq war is clear. Unlike previous conflicts, where women rarely were pulling the triggers or running the weaponry that left enemies dead on the battlefield, they routinely are doing so in Iraq, as Lt. Col. Rael pointed out on that cold December day on the outskirts of Baghdad.

On top of that they are being taken prisoner, as was Pvt. Jessica Lynch(am i alone in being sick of hearing the little waif's name?) during the initial invasion; they, like their male counterparts, are being constantly mortared and ambushed by a guerrilla insurgency; and they are watching fellow troops go home grievously wounded or dead in numbers not seen since the war in Vietnam.(welcome to the club ladies).

Killing `tips the scales'

"It all adds up," said MacNair, "but the act of having killed does seem to be the factor that tips the scales in favor of PTSD."

Of the nearly 245,000 veterans returning from Iraq and Afghanistan (news - web sites), almost 12,500 have been to VA counseling centers for readjustment problems and symptoms of PTSD. In addition, a study in The New England Journal of Medicine (news - web sites) found that up to 17 percent of troops returning from Iraq were suffering from PTSD or other readjustment problems.

So far no statistics have been released detailing how many of these patients are women, but numerous support groups have sprung up specifically for women with PTSD. In one Internet chat group, Sisters Bound by Honor, women struggling with PTSD talk with one another about their experiences.

Yet the women who most need counseling to help them deal with what they witnessed in Iraq and Afghanistan--like their male counterparts--are the most unlikely to seek it.

A Defense Department study of combat troops returning from Iraq found that soldiers and Marines deeply suffering from PTSD and readjustment problems were not likely to seek help because of the stigma such an act might carry. In the study, 1 in 6 veterans acknowledged symptoms of severe depression and PTSD, but 6 in 10 of the same veterans feared their commanders and fellow troops would treat them differently and lose confidence in them if they sought treatment for their problems.

That seems especially true of women, who have fought for years to be assigned positions in the Army that once were off-limits to them. A number of female Iraq war veterans suffering from PTSD declined to be interviewed for this article.


Alert to early need

Still, former Army Lt. Col. Dave Grossman, who taught psychology at West Point and wrote the book "On Killing," which closely documented the link between killing and PTSD, believes the treatment of PTSD among the veterans of Iraq could be the most effective in combat history. Using an analogy to obesity, he said that after past wars, only those traumatized soldiers "who were 400 pounds overweight got attention or treatment."

"But now," Grossman said, "we are so sensitive to PTSD and its effects that we can notice the person who is the equivalent of just 20 or so pounds overweight, and we can help them then, long before they have the psychiatric equivalent of high blood pressure and heart attack."

The study of female veterans suffering from PTSD may be just such a start. The study includes hundreds of women and aims, among other things, to discover which clinical treatments are most effective for women with the disorder.

Half of the women will be treated through prolonged exposure therapy, in which each woman will be guided for 10 weeks through vivid remembering of the traumatic event or events until her emotional response decreases through "habituation." Schnurr, one of the study's directors, compares habituation to the way city dwellers grow immune over time to loud noises such as police sirens or car alarms.

"The goal is that the memory of the traumatic event is no longer as startling, as terrifying, when it comes," she said.

The other half of the women will be treated with what is known as "present-centered therapy," a treatment that focuses on helping a patient deal with her current life challenges rather than the memory of past traumas.

"Both therapies are appropriate and helpful to some degree," Schnurr said, "but we expect that the prolonged exposure will be the most effective. If that is the case, I think we will begin using that treatment much more--and more effectively--in the years to come."

Although the goal of the study is to determine which therapies work best for women suffering from PTSD, experts agree that if the study is conclusive it eventually may be applied to tens of thousands of Iraq war veterans, male and female alike.

"It is our hope that we can find ways to help these women," Schnurr said. "But, more than that, we are hoping to draw some conclusions that can help us in the treatment of PTSD across the board. That means men and women, soldiers and Marines, those who are suffering for reasons having nothing to do with combat at all."

Officer of Engineers

A while back just when I was starting getting serious with my wife, I read Men are from Mars, Women are from Venus (didn't do me much good but good for some entertainment). However, from the book, men don't talk much while women just like to talk just to communicate the emotion.

Men or women, we don't talk about kills.

__________________
Chimo

lemontree

A while ago I had read that an average man has the capacity to speak about 5000 words a day and a woman can speak 12000 words a day. Now if you remember when you got married the most common complaint a wife has is, "that you don't talk to me". Since you have already done talking at your office, you have exhausted your capacity of 5000 words for the day when you get back home, and your wife has not even completed half of her day's quota.

__________________

Cheers!...on the rocks!!

antelope

I think a large segment of those who entered the military prior to 9/11 did not take the possibility of going in combat seriously, this is especially true among those in support roles. When faced with combat these individuals seem much less prepared mentally to handle the experience. With woman disproportionately represented in this demographic I would expect higher rates of post traumatic syndrome among those who face combat stress.

In general military studies find that ALL people suffer the effects of "battle fatigue", "shell shock", or "post traumatic stress" and that in general there is a well mapped and medically understood progression of mental breakdown that can be correlated with real hours spent in real combat. The percentage of those that suffer battle fatigue has in general risen in modern time, especially during Vietnam. The reason for the rise in battle fatigue is related to a few factors. First the sheer amount of real hours a soldier spends in combat or in near combat conditions has tended to rise in modern combat since a lot less time is spent moving to the battlefield. Soldiers can be brought into battle relatively fast compared to days of yore when 99% of your time may have simply been marching there. As a result of modern medicine and safety equipment soldiers are for more likely to survive battle and return again for more battle. This therefor increases the amount of actual combat a soldier can survive thereby ushering him further down the metal process of battle fatigue. In days of yore few people physically survived enough hours of combat for battle fatigue to become a widely observed issue.

Some interesting thoughts on battle fatigue: Studies show that those with some combat but not a lot of combat tend to be the most mentally well adjusted. People with no combat experience tend to not take security and other safegards seriously. Those with some combat take these issues very seriously. With increasing combat however the safegards are taken less seriously and those with extreme hours of combat perform worse than those with no previous combat experience when it comes to soldier safegards. It would appear that "combat experience" appears to be of much value among soldiers new to combat but it appears to actually be a negative to soldier performance in time (not what is commonly believed). Those with an extreme amount of combat tend to be a danger to themselves and those around them. This group also is over represented when it comes to valor awards, which appears to some extent a result of fatalism that inhibits once instincts at self-preservation.

The human mind tends to progress in this fashion based on hours of combat: (Iwish I had the hours in combat chart---You would be surprised how rapidly people go through this)

No combat: I am special. Nothing will happen to me. I am not worried much about digging fighting positions etc. (At this point leaders need to force soldiers to perform their tasks and follow up)

Some combat: I am special. Things happen to people that don't do what I have been trained to do. If I do what I have been trained I will be fine. If I don't I could be hurt. (Soldiers at this point perform well in battle and do all things they were instructed to do. They tend to be your best soldiers.)

Some more combat: I am not special. Death in battle is a result of random factors but I can improve my odds by doing things as I have been trained. (These soldiers perform as well as the best soldiers but their mind is starting to be filled with doubts about their survival.)

Higher levels of combat: I am not special. Death in battle is an entirely random event. I do what I'm told because that's what we do but my heart isn't into building defensive positions and text book maneuver because it really doesn't make a difference. (These soldiers often are now senior NCOs and looked up to as a result of their experience. They are however often a danger to themselves. Their disdain for "the book" although trumped up to "experience" is often a result of advanced mental breakdown. These people often are not noticed as battle fatigue victims but they are.)

Extreme levels of combat: I am not special. Death is no longer random. Everyone will die. (These soldiers are heavily represented in the ranks of long war Medal of Honor winners. They tend to have no regard for their own lives when moving on the battlefield. They ignore even basic soldier safety skills. Few people live to this point. Those that do usually end of suffering "nervous breakdowns" or "shell shock". People at this point best serve the military in positions where they no longer face or are less likely to face actual enemy fire like in TOCs).

Veni Vidi Vici

Women(in general) argue about tickets more, and complain more when you detain them... so I can definitly beleive the above.


I'm not going to post into this thread too deep.... We hacked this to death when I first came to the board.

__________________
"Our citizenship in the United States is our national character. Our citizenship in any particular state is only our local distinction. By the latter we are known at home, by the former to the world. Our great title is AMERICANS…" -- Thomas Paine

Julie

Allow me since I haven't met my quota for today.

For one, talking is good for the soul when deeply troubled or in crisis, and is a stress reliever. "Bottling up," is not good, from a psychiatric point of view.

Secondly, the men talking here at WAB alone, hugely surpasses that of the women.

Just words for thought.

antelope

Woman bond by talking. Men bond by doing things together. That's why going out to dinner is a good date. Eating together bonds at the male level while the conversation bonds on the female level.

Here's an intersting man vs woman fact that can stop marital conflict.

A man's mind subconsciously filters out extraneous noise. A woman's does not. If a man is watching television and his back is turned to his wife and his wife starts talking the man does not hear what the woman says. Most woman are unaware of this fact and assume the non-response of a man is a result of being intentionally ignored which is not the case.

In experiments they can put earphones on a man or woman and have a recorded story go into each ear. With one story in one ear and another one going in the other ear they find significant differences in how the sexes do when tested on the stories.

If neither is told which story they are to be tested on or if both stories are tested woman do significantly better. If on the other hand both sexes are told ahead of time which of the two stories will be tested on before they hear the stories men do considerably better.

Anon

"For one, talking is good for the soul when deeply troubled or in crisis, and is a stress reliever. "Bottling up," is not good, from a psychiatric point of view."

Talking about something that annoyed me just re-annoys me all over again.

Julie

I can relate to that as well, for instance, every time I read one of your "woman in combat" threads. It's like, here we go again.

bonehead

Anyhoo,
Could it be that the people coming back from combat with PTSD are the ones that have a conscience. Then it is the ones who come back "normal" that are the ones we have to worry about. No one can fully prepare themselves for the horrors of war. Like it or not, combat changes people.

lemontree

Something is basically wrong in that assumption. I am yet to see such stress amongst my fellow men or troops, with kind of combat exposure that we have had.
That is true, but it is not battle fatigue. It may be that some things just become second nature while in that environment.
I don't agree. All that is required that such people be given a non-combat posting for a short tenure, to ease them and put them back with their units thereafter.

Anon

"...Death in battle is a result of random factors but I can improve my odds by doing things as I have been trained."

That was my attitude.

Anon

"I can relate to that as well, for instance, every time I read one of your "woman in combat" threads. It's like, here we go again."

I made no comments at all when i posted the article.

Do you feel the article sheds women in a bad light or something?

Julie

No, but like VVV said, the varied issues of men vs. women in combat have been hacked to death.

However, I would like to say that Antelope's post regarding the experiment of consciousness vs. subconsciousness with men and women was rather interesting. I think it depicts the differences between men and women, as to brain action/reaction theories.

I dabbled with psychology in college, and the "meeting of the minds" between men and women is still rather interesting to me.

Anon

"No, but like VVV said, the varied issues of men vs. women in combat have been hacked to death."

This article to me was more about how women react to combat than how women react to combat vs. men.

I can tell you one thing NOT mentioned in the article that i'd bet big money causes extra problems for some women is the extra attention they get from the press and such. As an example, how many of you knows the names of any of the troops from the 505th besides Jessica Lynch?

Being singled out for such attention when you feel inside you did nothing special(especially when people in their rush to annoit you a hero make up all kinds of glorious crap) is a sure fire way to cause additional deep emotional stress.