View the study on PTSD in the war in Iraq, from the New England Journal of Medicine.

View the frequently asked questions section of the National Center for PTSD's Web site.

E-mail Dusty Nielsen with questions or comments on this story.

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A war no peace treaty can resolve

Gary Delawyer walked down a Rice Lake street less than one month removed from his first tour in Iraq with the U.S. Marines.  Delawyer patrolled the streets of several Iraqi cities, including Baghdad, and was under constant fire from enemy soldiers.  On his first patrol, a bomb exploded less than 30 meters from where he stood.

It was late June 2003 and Delawyer was on his way to his brother’s house in Rice Lake. A child set fire to the fuse of an ordinary firecracker less than a block away.  Bang!  Delawyer instinctively dropped to the sidewalk and rolled to safety behind a nearby tree.

“You just get so used to being under fire,” said Delawyer, who served two stints overseas with the Marines.  “It takes some time to get back to reality.”

Delawyer and countless other military personnel are dealing with life after battle.   While other aspects and effects of the U.S.’s involvement overseas often overshadow the topic, the war in Iraq is leaving lasting effects on the soldiers who risked their lives for their country.

When military personnel return home from fighting overseas, the fighting doesn’t always end, say experts.  A recent study shows that one in eight soldiers returning from the war is diagnosed with Post-Traumatic Stress Disorder, a psychiatric disorder that can occur following the experience or witnessing of life-threatening events, according to the National Center for PTSD.  Some who saw action struggle to rid the memories of experiences in the war.  Others say that the stress of war changes people; often enough that loved ones back home no longer recognize them.

A variety of options are available to military personnel suffering from PTSD, say experts.  But only about half of military personnel diagnosed with PTSD are seeking treatment, according to a study in the New England Journal of Medicine.  The reasons are vast, ranging from a worry that their peers will perceive them as weak to a mistrust in mental health professionals.  The effects of PTSD can be long lasting and devastating if not handled by a mental health professional.

The stress of war

Earlier this year the New England Journal of Medicine released a study that examined the perceived mental health problems of U.S. forces in both the Army and the Marines.  The results showed that 19.5 percent of soldiers in the Army and 17.1 percent of troops in the Marines had a perceived moderate or severe mental problem after deployment to Iraq.  Only 14.3 percent of soldiers in the Army were diagnosed with the same problem before deployment to Iraq, while no data was given for Marines before deployment, according to the study.

Lt. Col. Susan Whitaker, who serves in the Army as a combat operational stress control officer, said that some soldiers who have fought overseas have different, more extreme reactions to the stress they encounter.

“It all comes down to how they (soldiers) deal with the stress they are under,” said Whitaker.  “Some are not as able to handle it as well as others.”

The numbers in the study in the New England Journal of Medicine support Whitaker’s view.  One of the major negative reactions to stress in the Armed Forces is the consumption of alcohol, according to the study.  Before deployment to Iraq, 17.2 percent of Army soldiers reported using alcohol more than they meant to while 12.5 percent admitted they felt the need to cut down on their drinking.  Compare that to their return home from Iraq, when 24.5 percent reported using alcohol more than planned and 18.2 percent felt the need to cut back.  While no numbers are given for Marines before deployment, 29.4 percent of returning troops said they felt the need to cut back their consumption of alcohol.

Shane Strand, who served in the Navy off the coast of Kuwait on the USS Nimitz from March to November 2003, said many of the military personnel he worked with over-consumed alcohol when they had the chance.

“When we’d have a short leave or get a day when we could drink on board,” said Strand, “some of the guys would just go crazy.”

Strand said that once a month his crew would be allowed to drink two beers apiece, but many on board had ways of obtaining more.  They would go around the ship and find the people who didn’t drink, said Strand.  Then they would offer to buy the two beers from them.

“Guys would do that until they had so much beer they were completely s---faced,” said Strand.

While alcohol abuse is not a sure sign of PTSD, the two do often occur together, according to the National Center for PTSD.  To complicate things further, PTSD symptoms are often worsened by alcohol abuse.  Those who suffer from the disorder use alcohol to provide a temporary feeling of relief.  This can often impair the ability to both sleep well and cope with stress.  The combination of alcohol abuse and PTSD can also lead to other serious disorders in as many as 50 percent of adults, according to the National Center for PTSD.  Some of the disorders include anxiety, mood, disruptive behavior, and addiction disorders.

PTSD is not a new disorder.  According to Findings from the National Vietnam Veterans’ Readjustment Study, 15.2 percent of male veterans of the Vietnam War were diagnosed to have had PTSD at the time of the study while 30.9 percent of them were diagnosed to have had the disorder at some point in their life.  Only 8.5 percent of women veterans of the Vietnam War had PTSD at the time of the study, but 26.9 percent were diagnosed to have had it in their lifetime.

A different person returns home

When Strand returned home in November 2003 from his duty overseas, he said he felt like he had accomplished something.  But he said he didn’t feel like a changed person.  Those who knew him before he was a member of the Navy disagreed.

Bret Kittleson, a long-time friend of Strand, said that he acted differently when he returned home.

“He just seems quieter now than he used to,” said Kittleson, “and he drinks more.  He always used to drink but not as much as he does now.”

Kittleson has known Strand since the two of them were in kindergarten class together.  He said his friend now has a more cynical view of things and that the two of them are not as close as they once were.  Strand said that he doesn’t feel any different. 

While he doesn’t acknowledge a change in himself, Strand said he did notice changes in many people aboard the Nimitz with him.  He said many of the military personnel onboard were “stressed out,” often leading to fights between one another.

“It wasn’t only stress from being away from home,” said Strand, “but stress from home.  A lot of guys’ wives would leave them, or cheat on them, while they were gone.  They’d just leave them high and dry when they were thousands of miles away.”

Capt. Charles Lewis, who saw action overseas from May 2003 to May 2004, now works with the soldiers returning home from war, as well as some of their families.  Lewis says that many families don’t realize that their loved ones may change, and that stress is often the cause.

“Some people react to war differently,” said Lewis.  “Some are more mentally and physically prepared than others.  They (soldiers and families) just have to deal with it.  The military has resources in place to recognize the problem (stress).”

Battling back

Lewis and Whitaker are both part of the military’s acknowledgement of the problem of post-combat stress.  Lewis, who still serves in the Army at the Eau Claire Army Reserves office, is a family readiness liaison.  Part of his job is to work with families and get them ready for what it might be like when their loved one returns home from the war.

Whitaker, who also deals with soldiers and their families, does much of the same as Lewis.  But she also deals with couples who are not yet married.  She is part of a program in Minneapolis called the Premarital Relationship Enhancement Program that extends its services into Wisconsin, including Eau Claire.  The program is a three-day marriage seminar that helps ease the stress between couples.

“What we do is talk to them and listen to them,” said Whitaker.  “I help them out with whatever they need to resume being a normal couple, whether that’s getting them money, help or babysitters.”

PREP and other military installed programs are just some of the many options available to those who seek help with PTSD.  The American Psychiatric Association lists five main treatments for PTSD, two of which are family therapy and discussion groups, which the military has already put to use.  The remaining three treatments are behavior therapy, psychodynamic psychotherapy and medication.  Psychodynamic psychotherapy is generally a technique used in cases of PTSD that have existed since childhood and is rarely used in military cases.

Prior to a method of treatment, however, the National Center for PTSD notes that each individual and case is unique.  Therefore the treatment of PTSD usually begins with an evaluation of the person and the development of a treatment plan.  It also states that the beginning of a successful treatment is the education of the patient on what PTSD is.

Behavior therapy is one of the most common and successful treatments of PTSD, according to the American Psychiatric Association.  The treatment involves ridding the patient of their patterns of behavior by teaching relaxation techniques and examining the mental processes that are causing the problem.

Medication is often used in cases of PTSD in conjunction with other types of treatment, such as behavior therapy.  The medication is used to relieve anxiety and depression and often makes the patient more open to other types of therapy.  Several drugs have shown promise in helping cure PTSD but no one drug has emerged as a definitive treatment, according to the National Center for PTSD.

An unwilling soldier

Even though there are numerous options for treatment of PTSD in military personnel returning from war, the study in the New England Journal of Medicine reports that very few are actually seeking help.  Of the soldiers in the Army surveyed after deployment to Iraq who had a perceived need for mental health services, 78 percent acknowledged the need for help, but only 43 percent were interested in receiving help.  Only 27 percent of soldiers received help from a mental health professional in the past year.

The statistics were much of the same for the Marines.  After deployment to Iraq, 86 percent of troops with a perceived need for help acknowledged the need, but only 45 percent were interested in receiving treatment.  Only 21 percent reported they had received help from a mental health professional within the past year.

It is clear from the study that a majority of military personnel are not interested in receiving the help they need.  But what would keep them from receiving professional treatment?  Lewis said that soldiers in the Army realize that stress is part of war and deal with it.

“They (soldiers) know that they are not any less of a soldier because of it,” said Lewis.  “Everybody recognizes it and deals with it.”

But the numbers in the study by the New England Journal of Medicine contradict Lewis.  In a survey of perceived barriers to mental health treatment, 65 percent of military personnel from both the Army and Marines were worried that they would be seen as weak if they were to seek treatment.  Sixty-three percent thought they might be treated differently by their unit leadership while 59 percent thought the members of their unit would have less confidence in them.  Fifty percent thought seeking help would harm their career and 41 percent thought it would be too embarrassing.

A worry of reputation loss was not the only reason many military personnel didn’t seek treatment.  According to the study, 55 percent reported that it would be difficult to get time off of work for treatment and 45 percent said it was difficult to schedule an appointment.  But the problem might go deeper than simply time.  Trust may also be a barrier to treatment.  Thirty-eight percent of the military personnel surveyed said that they did not trust mental health professionals, but no reason was given for the lack of trust.

Losing the war

When military personnel suffering from PTSD do not receive treatment, the cost may be steep, according to the National Center for PTSD.  Those who do not seek treatment often use negative coping actions to deal with the problem.  These actions can include alcohol or drug abuse, isolation, workaholism, violent behavior, unhealthy eating, the angry intimidation of others, and even self-destructive behavior.

Those who don’t seek professional treatment fall back on these things as a short-term treatment, according to the National Center for PTSD.  But the habits they develop are usually hard to change and lead to long-term effects.

The long-term effects of drug and alcohol abuse are obvious, but other negative coping actions can lead to just as serious effects.  Social isolation will result in loss of friendships, social support and intimacy, according to the center.  A fallback on anger often leads to many of the same problems and can cause work problems and marital/relationship problems.

The National Center for PTSD warns against continued avoidance of help for those suffering from the disorder.  While avoidance may keep the stress low, it ultimately inhibits the ability for the person to make progress and learn how to deal with the stresses they encounter.

“Mortars and AK47’s are an everyday occurrence over there (Iraq),” said Lewis.  “Soldiers who need help can’t be afraid to get it.”