'The doctor is in' when troops need to work through the consequences of war
September 10, 2003
FALLUJAH, Iraq — This is the Wild West. It always has been.
Iraqis say that even Saddam Hussein’s methods of mass murder couldn’t pacify the area around Fallujah and Ramadi, about an hour’s drive west of Baghdad.
Now the unenviable mission of bringing the region under control falls to the Brave Rifles — the 2nd Squadron, 3rd Armored Cavalry, at a base called MEK.
Guerrillas in the sector have killed at least two U.S. soldiers and wounded a dozen since late August. So it would figure that if Dr. Michael Banton, an Army lieutenant colonel, were going to be hanging around some place, it would be Fallujah.
Banton, a psychiatrist, leads the 113th Combat Stress Control Company, under the Heidelberg, Germany-based 30th Medical Brigade. It is one of four combat stress detachments of seven or eight people working across Iraq. Teams consist of officers who are psychiatrists, psychologists and social workers, as well as enlisted mental health experts.
Banton describes himself as the modern version of Sidney Friedman — Sigmund Freud’s empathetic acolyte in the “M*A*S*H” television series. Friedman was the congenial shrink who always showed up to talk to soldiers and doctors through the horror. Casual. Funny. Irreverent. Compassionate.
Banton is not much different. A tall, relaxed man, he has the air of a guy just hanging out. But he is a man with a mission.
His job is to help soldiers who have just lost a comrade in arms to recover from the hard times and make sure they are in shape to continue their mission. When he was at MEK in late August, the 3rd ACR had just had a suicide on top of the two soldiers killed, he said.
“If I do my job here, I won’t be seeing them five years from now in my office,” said Banton, a reservist with a private practice in St. Louis.
Banton believes it is best to keep soldiers with their units, and to get them back to their jobs as soon as possible. That’s best for the soldier and unit manning, in his opinion.
It is also a departure from how the Army used to do things.
During World War II, when the Army lost one out of four soldiers to what was called “battle fatigue,” soldiers were evacuated to the rear, Banton said. But taking soldiers from their units decreases chances of recovery, he added.
Now, stress teams go to soldiers for “critical-event debriefings” from between 24 hours and 72 hours after an incident. Had this method been in place during World War II, Banton believes the military could have returned 80 percent of battle stress victims to duty — as it does now.
While the Army has had such teams for a decade, it keeps refining methods to match societal changes.
The “Dear John” e-mail, for example, is “the modern curse for soldiers,” Banton said. So combat stress teams use a broad spectrum of treatments, including relaxation techniques, anger management, problem-solving and working through home front issues. Even massage.
What the teams don’t practice is “a touchy-feely” sort of therapy, Banton stressed. “We’re not going to ask you if you want to sleep with your mother,” he said.
The idea is to “normalize the event to some extent” for the soldier “who’s just seen his buddy’s leg shot off,” he said.
War “is an abnormal event, but we assure soldiers they’re experiencing normal reactions — tears, anger, denial — to violence and death,” the doctor said.
Banton said the most important thing his team can do for soldiers is to listen.
Officials with the 3rd ACR declined to make available soldiers who had talked to combat stress teams, citing privacy and patient/doctor confidentiality concerns. But one officer who has sat in on the sessions describes them as effective, even essential.
“It’s almost like a group therapy session,” said Maj. Chris Kennedy, squadron operations officer. “Like an after-action report. I was surprised how willing people were to participate. They talked out freely, openly.”
Combat stress teams try to include everyone on an affected mission in the sessions, which are led by the psychiatrist, Kennedy said.
Sessions go step by step, from getting soldiers to talk about what they saw, to discussing how it made each feel, and finally to getting any help the soldiers need, he said.
Typically, soldiers go through distinct phases: denial, anger and finally survivors’ guilt, blaming themselves for a buddy’s death or injury. It’s common for soldiers to replay events over and over, asking themselves if they made a mistake, Kennedy and Banton said.
“I watched soldiers go through all the symptoms,” Kennedy said. “Not necessarily in that order. But before they were through, they went through each stage.”
“I had a soldier say, ‘What if I’d just turned my Bradley to the right? I’d have seen that guy,’ ” Banton said. “In his mind, his friend would still be alive. You have to talk them through it. Make them realize everyone did their best.”
After an incident, speed is of the essence, Kennedy added. Though it takes about 48 hours for events to settle enough to talk about them, any longer “and you’ve waited too long,” he said.
One session didn’t happen until four days after an attack because the unit was moving, Kennedy said. “One soldier said, ‘I wish we’d done this earlier. I had just started to be able to deal with it.’ It [the session] was basically digging it up. Meaning, they go through it all over again.”
Kennedy is a believer in the effectiveness of the sessions.
Despite his unit taking multiple hits, the 2nd Squadron hasn’t evacuated one soldier, he said.
“I would hazard to say … they’re lifesavers, especially in Fallujah” where guerrillas attack the 2nd Squadron “every single day.”