Health Officials Battle Combat Stress

"Many things beside combat can cause a combat stress reaction," said Army Dr. (Lt. Col.) E. Cameron Ritchie, director of Mental Health Policy and Women's Health for the Office of the Assistant Secretary of Defense for Health Affairs. "We may have less combat action today, but we still have danger and sleep deprivation, in training exercises and deployments."

Ritchie said service members today have to deal with the sight and smell of dead bodies on peacekeeping missions, accidental deaths of unit members, and "working in an environment where people you came to help are shooting at you, as in Somalia." Any of these things can cause a combat stress reaction, she said.

"Some people are very critical of the term 'combat stress control,' because we're seeing a lot of situations other than combat," she said. "We're seeing 'operational stress.' That's really the term I prefer."

Commanders should be aware that home-front stresses often cause difficulties. "A person may be doing great where he is, but it's the news that his wife is divorcing him, or his kid is having problems in school, or he needs to figure out what to do with his elderly parents that becomes a precipitating factor", Ritchie said.

Two aspects differentiate a "perfectly normal" reaction to trauma and a more severe reaction that requires professional treatment -- how long the reaction lasts and its severity.

"It depends on the symptom," Ritchie said. "Nightmares might go on for weeks, but uncontrollable shaking shouldn't last more than a few hours. If someone becomes suicidal or even homicidal it becomes a medical issue. The chain of command should work closely with their medical team to provide the service member immediate help."

DoD mental health experts are trying to emphasize to the services the importance of combat stress control to the overall health and fitness of the force, Ritchie said. DoD Directive 6490.5, signed Feb. 23, 1999, attempts to implement combat stress control policies throughout the department.

The Army has devoted dedicated resources to combat stress control with active and reserve combat stress control units. "The chaplain is a good resource when medical personnel aren't immediately available," Ritchie said. "Corpsmen and medics should also be trained in the basic ideas of combat stress control."

"Initial treatment is simple," Ritchie said. "We use the phrase 'three hots and a cot.' I personally think it should be 'three hots, a cot and a warm shower. My mental health goes down drastically after a couple days without a shower."

She said soldiers need to know that psychological reactions to traumatic events are normal. Ritchie explained it's also important to treat combat stress casualties as close to the front or to their units as possible and with the understanding they will return to duty. "We've found that if you ship people out of their units, most never go back, and they don't recover as well," she said. "There's quite a bit of stigma attached to being removed from a unit, and some of these people develop chronic psychiatric conditions."

But, Ritchie explained, this policy is also for the unit's benefit. "One of the things we explain to the commands is that 80 to 90 percent of these people can be returned to duty usually within three days," she said. "If you start evacuating large numbers of soldiers, you're going to have an epidemic, especially if you get into a situation where there's real combat."