Terror on the Frontlines
January 11, 2004
You’ve got a wicked battle cry, been trained to kill with anything you can get your hands on, or with nothing but your hands. You have washboard abs and a fanged rattlesnake — ready to strike — tattooed on your forearm.
You’re battle ready and you ache for action.
Now you’re on the front lines. Real bullets fly in all directions. Howitzers rattle your dental fillings.
You see an enemy soldier’s face wad in pain as he clutches his shoulder where an arm used to be.
Bam! You freeze, and you’re milking a cow at your uncle’s dairy farm. It’s a sweet-smelling day. The cow’s flank is soft against your cheek; the sun is warm. You almost could doze off.
Until your sergeant puts his boot to your rump and shakes you so hard you bite your tongue.
You detect acrid odors, hear screams and explosions. And you feel sick: You lost it when you needed it most, and when your comrades needed you most, you let them down.
Tell us, young patriot: What does this make you in the clearly defined military world?
How about normal? You just experienced combat stress — and it happens more than you think.
“You have to understand that battle stress is not a psychological problem, but a very normal reaction to an abnormal situation,” Petty Officer 2nd Class Juan Carlos E. Montgomery, a psychiatric technician with the 1st Marine Expeditionary Force, explained in a recent Marine news report.
Symptoms include intrusive memory loss, repetitive nightmares, reliving trauma, flashbacks and becoming hyper-vigilant or fearful, according to the Virtual Hospital Web site.
Combat stress comes in different forms, or stages, said Lt. Cmdr. Brian Hershey, a psychologist at Yokosuka Naval Hospital, Japan. As with the hypothetical, cow-milking Marine, emotional and physical paralysis can grip someone at just the moment his mobility is most valuable.
“When a unit initially goes into combat,” usually within the first five days, Hershey explains, “you’re going to have those guys, that — because of the carnage or whatever, or because they’ve never been in it before — are going to have a combat stress response.
“These are the ones who maybe freeze, or they become speechless, or they stare off out into nowhere. The reality of combat is just so different from anything they may have imagined. It’s so different than the training,” he said.
Ray Welch, 54, a retired Marine captain, said it happened to him during his first combat exposure in Vietnam. “When you actually get into that carnage, you’re going to have a group of people who are overwhelmed.”
Welch is the community coordinator for Marine Corps Community Services at Camps Hansen and Schwab in Okinawa. He fought in the Tet Offensive in 1968 as a lance corporal with the 1st Battalion, 7th Marines.
“I kind of froze, and just couldn’t do anything and didn’t know what was going on,” he said. “I only came out of it when an outstanding NCO made me move from my foxhole to another one. Apparently, I was in the wrong hole.”
Another form of combat stress can appear about 60 days into a combat mission, or after repeated battle stints. “It’s sometimes called ‘old sergeant’s syndrome,’” Hershey said. Or “shell shock,” “battle fatigue,” — and more recently, “post-traumatic stress disorder.”
Many people experience anxiety, trouble sleeping and occasional nightmares, said Army Lt. Col. Elspeth Cameron Ritchie, mental health policy and women’s issues director, Office of the Assistant Secretary of Defense for Health Affairs.
“What differentiates combat stress is usually the intensity,” she told the American Forces Press Service recently. “Sometimes you’ll have repeated memories and intrusive thoughts focusing on what happened.”
Ritchie emphasized combat stress symptoms are “normal reactions to abnormally stressful or traumatic situations.”
“It’s something you just can’t predict,” Hershey said.
Combat stress is nothing new.
During World War I, the French and British discovered that if stress casualties were evacuated far to the rear, many became chronic psychiatric cripples. If treated quickly close to their units, most recovered and returned to duty. The U.S. Army Surgeon General of that time recommended the U.S. adopt a three-echelon system for prevention, triage, treatment and return to duty of stress casualties, according to an historical perspective reported in the U.S. Army’s Leaders’ Manual for Combat Stress Control: Booklet 1.
The Army’s first echelon of treatment was to attach a trained psychiatrist to each division. The psychiatrist’s role was “to advise the command in the prevention of stress casualties, to screen out the unsuitable, and to assure that overstressed soldiers were rested and returned to duty within the division whenever possible,” the report states.
“Following British practice, stress casualties in the division were labeled ‘Not Yet Diagnosed, Nervous’ (NYDN). This avoided even the suggestion of physical injury implied by the dramatic popular label ‘shell shock’ or the implication of psychiatric illness conveyed by the official diagnosis of ‘war neurosis,’” the report added. Under good conditions, 70 percent of stress casualties were returned to duty within the division.
Decades later, in World War II, the 6th Marine Division fought day after day in the Battle of Okinawa against dug-in Japanese with heavy artillery. Wounded in action: 2,662 Marines. Combat exhaustion casualties: 1,289, according to the Virtual Naval Hospital Internet site at www.vnh.org/FM22-51/01FM2251.html.
For every two Marines with physical wounds, one more suffered emotional trauma so debilitating they were evacuated to Navy ships offshore. Few ever returned to duty, according to the Web site.
In Vietnam, battle fatigue casualty rates rarely exceeded one per 10 wounded in actions, the Army report states.
“The reasons for the few battle fatigue casualties included the sporadic nature of fighting and our air and artillery superiority. Other factors were well-supplied firebases, scheduled rest, recuperation and a fixed combat tour. All these factors kept most battle fatigue cases at levels which could be treated in their units and did not require medical holding or hospitalization,” the report explained.
Although improved treatment might minimize the effects of combat stress, the condition likely will be part of a combat veteran’s life as long as there is war, said Cmdr. Harry W. Griffith, Sasebo Naval Base’s former command chaplain, who recently transferred to a Navy theological teaching post in New England.
There is a great truth about combat that any potential battle-bound servicemember should know, he added.
“War depersonalizes human beings,” Griffith said. “At some point early on, you realize the enemy also has children, and they have families and wives, too. But they will shoot you, and they will kill you.
“You can never get comfortable with war,” he said.