The Struggle to Gauge a War's Psychological Cost

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It was hardly a traditional therapist's office. The mortar fire was relentless, head-splitting, so close that it raised layers of rubble high off the floor of the bombed-out room. Capt. William Nash, a Navy psychiatrist, sat on an overturned box of ready-made meals for the troops. He was in Iraq to try to short-circuit combat stress on the spot, before it became disabling, as part of the military's most determined effort yet to bring therapy to the front lines.

His clients, about a dozen young men desperate for help after weeks of living and fighting in Falluja, sat opposite him and told their stories. One had been spattered with his best friend's blood and blamed himself for the death. Another was also filled with guilt. He had hesitated while scouting an alley and had seen the man in front of him shot to death. "They were so young," Captain Nash recalled.

At first, when they talked, he simply listened. Then he did his job, telling them that soldiers always blame themselves when someone is killed, in any war, always. Grief, he told them, can make us forget how random war is, how much we have done to protect those we are fighting with. "You try to help them tell a coherent story about what is happening, to make sense of it, so they feel less guilt and shame over protecting others, which is so common," said Captain Nash, who counseled the marines last November as part of the military's increased efforts to defuse psychological troubles. He added, "You have to help them reconstruct the things they used to believe in that don't make sense anymore, like the basic goodness of humanity." Military psychiatry has always been close to a contradiction in terms. Psychiatry aims to keep people sane; service in wartime makes demands that seem insane.

This war in particular presents profound mental stresses: unknown and often unseen enemies, suicide bombers, a hostile land with virtually no safe zone, no real front or rear. A 360-degree war, some call it, an asymmetrical battle space that threatens to injure troops' minds as well as their bodies. But just how deep those mental wounds are, and how many will be disabled by them, are matters of controversy. Some experts suspect that the legacy of Iraq could echo that of Vietnam, when almost a third of returning military personnel reported significant, often chronic, psychological problems.


http://www.nytimes.com/2005/11/26/health/26psych.html?hp&ex=1132981200&en=7bbf84e7c46adb8d&ei=5094&partner=homepage

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1. Not to mention psychological effects on rest of world...hating US? nt