The U.S. Army's Ambitious Fight Against PTSD

Mental Combat Chris Koehler

The roar of the chopper’s engines made it hard to hear. First Sgt. James Kelley signaled with his hands and yelled: “Five minutes!” In the murky light of the Chinook’s cargo bay, rows of helmeted figures sat surrounded by rifles and camouflage rucksacks. It was four in the morning. Bulldog Company from the U.S. Army’s 101st Airborne Division, along with dozens of Afghan National Army soldiers, forward air controllers, military intelligence officers, and bomb-dog handlers, were air-assaulting into enemy territory. Under the light of the full moon, rows of mist-shrouded grapevines and mud compounds rushed below.

The mission, Operation Lion Strike, was to land in a Taliban-controlled area in one of the most violent parts of Kandahar Province, southern Afghanistan. The soldiers would then push northward, into a cluster of villages Army command suspected of harboring insurgents and weapons caches. By landing before dawn, the soldiers hoped to surprise the insurgents, preventing them from setting up ambushes or laying improvised explosive devices, or IEDs. For added insurance, they had ordered F-15 jets to drop 500-pound guided bombs above the landing zone; the pressure wave would help trigger any IEDs the insurgents might have already hidden.

I had embedded with Bulldog Company to understand firsthand the conditions that forward-deployed infantry routinely experience during the course of combat—conditions that are causing a mental-health crisis in the military. Suicides among service members have outpaced combat deaths. In other words, the young men around me in the Chinook were more likely to die by their own hand than by the Taliban’s.

For an uninitiated civilian, an assault into Taliban-held territory is an overwhelming experience. My heartbeat and adrenaline spiked as my nervous system’s fear response kicked in. My sense of time shifted; events felt simultaneously rushed and glacial. Later, I noticed that my memory of the assault was filled with gaps.

Yet something different was unfolding in the minds and bodies of the soldiers of Bulldog Company. They had done this so many times during training that they were operating from muscle memory. The surge in stress sharpened their attention, heightened their performance.

Becoming good at war often involves becoming bad at peace.
The problem is, becoming good at war often involves becoming bad at peace. In every 20th-century conflict the U.S. has fought, more American soldiers have been psychiatric casualties than have been killed in combat. Since 2001, the Department of Veterans Affairs has diagnosed more than 200,000 veterans of the Iraq and Afghanistan wars with post-traumatic stress disorder (PTSD)—nearly four times as many as were injured or killed. And while most soldiers readjust well to civilian life, a significant portion struggle. In addition to the spike in suicides, cases of spousal or child abuse and neglect, and referrals for drug and alcohol abuse, have increased among service members.

The Chinook banked hard to the right, slowed, and sank rapidly, its tail dipping downward. A ripple ran through our lines as the men started to shrug on their gear and wield their rifles. We stood up, grasping at each other for assistance in the narrow confines of the cargo bay, then shuffled toward the open bay door. The moonlit field of grass, flattened by the downwash of the rotor blades, came into view as the chopper dipped its back ramp against the turf.

“Let’s go!” shouted Sgt. Kelley.

And then we were on the ground, jogging through the heat of the helicopter’s exhaust. The soldiers fanned out and hit the dirt, and the chopper’s engines screamed as it clawed its way into the night.

The trauma of war has been a subject of literature since Homer’s Iliad, but it only entered medical discourse during World War I, when doctors coined the term “shell shock.” They thought the new phenomenon of days- or weeks-long artillery bombardments were rattling the brains of soldiers, causing infantrymen to experience problems that ranged from nightmares to uncontrollable tremors. By the end of the war, however, doctors had come to understand that what they called shell shock was more than physical—it was also emotional.

During World War II, psychologists replaced shell shock with battle fatigue, which described the condition as overwhelming physical and mental exhaustion. After the Vietnam War, researchers better understood what the brain and body go through in combat. They knew that a complex mixture of psychological and physiological reactions trigger anxiety and intense flashbacks in many soldiers. And in 1980, PTSD—a term covering a variety of symptoms that occur after exposure to trauma, including hypervigilance, insomnia, flashbacks, and inappropriate emotional responses to everyday situations—entered the Diagnostic and Statistical Manual of Mental Disorders.

Over the past decade, the two million American service members deployed in combat zones have provided military researchers with the largest body of data on PTSD since the Vietnam War. Now the Army, in collaboration with the National Institute of Mental Health, has implemented a massive $65-million epidemiological study known as STARRS, which collects blood samples as well as surveys from more than 100,000 current soldiers and new recruits. The aim is to identify risk factors for combat stress and suicide. The study will wrap up next year.

That, of course, will be too late for soldiers who have already been deployed. For them, the Army has rolled out a variety of programs designed to fight PTSD. One, a $125-million initiative called Comprehensive Soldier and Family Fitness (CSF2), seeks not to treat PTSD but to prevent it—to create enduring soldiers for an age of enduring conflicts. It is an unprecedented, integrated training regimen designed to manage all aspects of the soldier’s well-being: emotional, social, physical, and even spiritual. But will it work? For that matter, can anything prevent PTSD?