The Toll Killing Takes on US Soldiers

San Mateo Times (CA)

The beefy Army drill sergeant has been a soldier since he was a teenager. Now 35, he was eager to go to war with the Third Infantry Division and do for real what he had been teaching recruits. But after at least five confirmed kills, he discovered combat was different than he had expected.

“I didn’t think it would be like this, killing people,” Staff Sgt. Thomas Slago reflected, not long after squeezing the trigger on his assault rifle to stop an approaching Iraqi guerrilla, then watching the gruesome result through his scope.

“He exploded like a watermelon,” Slago said.

In numbers not seen since the Vietnam War, trauma experts say, soldiers soon will return home from battle forever changed by what they’ve seen and done.

War in Iraq has meant machine-gunning guerrillas intent on suicide charges. It has meant gunplay in neighborhoods, building corridors and desert bunkers.

Marine Cpl. Clint Begley of Shreveport, La., approached a bunker thinking, “I don’t know if there are three or 30 in there. Oh my God, am I going to have to shoot that guy?”

He did. So did his platoon mate in the 15th Marine Expeditionary Unit, Cpl. Juan B. Elenes, 21, of Portland, Ore. In another bunker, Elenes shot off the top of an attacker’s head. Then a second man. “I didn’t want to get shot, so I shot him first,” Elenes explained.

Afterward, he said, “OK, I’m done. I’m ready to go back to Kuwait now.”

The presence of Iraqi villagers and irregulars in civilian disguises added to the stress and confusion.

“I didn’t expect the whole civilian thing,” said Lance Cpl. Jack Self, never taking his finger off the trigger of his grenade launcher. He watched a woman tugging two heavily laden donkeys away from a stone house that could provide cover to snipers. He had blasted other buildings like it and found bodies in the rubble.

“Part of me wants to kill everything I see. You just can’t trust anybody,” he said. “I hope there’s nobody in that building when I destroy it.”

Veterans centers are posting trauma advice on Web sites for both soldiers and their families. They are expanding treatment programs for that fraction of soldiers who need special help.

“There will be a lot of work to do when the men and women come back from Iraq,” said psychiatrist Matthew J. Friedman, executive director of the National Center for Post-Traumatic Stress Disorder and a researcher at Dartmouth College. “We’ve had killing and we’ve had death and injuries. We’ve had civilians killed. There was a fragging.”

How many soldiers will require mental health treatment? Past conflicts offer clues.

A nationwide, long-term study of Vietnam veterans — now entering its third phase — concluded that one-third of combat soldiers returned emotionally wounded. After the 1991 Persian Gulf War, about 10 percent of the troops suffered distress from a conflict that was much briefer and less intense.

Given the confusing, urban ambush-style fighting in this Iraq campaign, experts predict trauma levels closer to Vietnam’s.

Counselors say most soldiers reconcile disturbing memories with the support of family and veterans’ groups. Reflections on good deeds — rescuing wounded comrades, liberating an oppressed nation, distributing humanitarian aid — can help protect soldiers’ fragile psyches.

But, psychologists agree, a portion of combatants will develop disabling psychiatric illnesses as episodes of fear and violence imprint on their memories, triggering biological and chemical changes that change how their brain cells function.

Fifteen years after being discharged, the post-Vietnam study shows, 15 percent of veterans still suffered from PTSD, the most serious of trauma reactions.

Former West Point psychologist Dave Grossman said soldiers must be trained intensively to overcome the natural reluctance to kill other people.

“When faced with a living, breathing opponent, a significant majority of soldiers revert to a posturing mode in which they fire over their enemy’s heads,” Grossman, a retired lieutenant colonel and former Army Ranger, wrote in his book, “On Killing: The Psychological Cost of Learning to Kill in War and Society.”

Traumatized soldiers relive their horrors through flashbacks and nightmares, often followed by depression or fury.

One Vietnam vet told Boston psychiatrist Jonathan Shay: “I really haven’t slept in 20 years. I’m always watching the door, the window. I get up at least five times to walk my perimeter, sometimes 10 or 15 times.”

The brains of PTSD patients show shrinkage of the hippocampus and abnormal activity in the amygdala, small structures associated with memory. The sympathetic nervous system — which is centered in the spinal cord and controls the fight-or-flight response — works overtime years after the danger has passed. PTSD patients continue to produce abnormal levels of key stress hormones and high levels of natural opiates that the brain produces to calm itself.

A recent study at Fort Bragg, N.C., shows PTSD patients have lower levels of a neurotransmitter produced in the hippocampus called neuropeptide Y.

Now the Army wants to know if it can select more resilient soldiers by measuring neuropeptide levels. Future soldiers might get NP-Y booster shots to vaccinate their brains against PTSD.

PTSD treatment includes counseling and exposure therapy, in which patients repeatedly recall their frightening memories to become less sensitive to them. Drug treatments include depression medications. Israeli researchers are testing a drug to regulate the protein AChE, which protects brain cells from becoming hypersensitive after stress.

Meanwhile, the Pentagon has modified training and certain battlefield practices to address PTSD.

Units remain together longer and drill in realistic war games. In Iraq, soldiers conducted battlefield rites for fallen comrades. After battle, commanders encouraged troops to openly discuss their fears. During combat, more psychologists and social workers helicopter to forward lines.

More help awaits back home for those soldiers who need it.

Al Batres, who administers the VA’s 206 veteran centers nationwide, says, “The Iraq war has high-tech weapons like the Persian Gulf War. It has street warfare like Somalia and combat like Vietnam. But this war has more controversy and protests like Vietnam, too.”

As vets return home, he says, “They need to know that it’s OK to talk about your experiences in battle. It’s therapeutic.”

VA’s Vet Center Directory:

VA’s National Center for Post-Traumatic Stress Disorder:

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