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Friday, April 22, 2011

Soldiers trained to kill, not to cope

By Joseph F barber,
NAJAF, Iraq — Tucked behind a gleaming machine gun, Sgt. Joseph Hall grins at his two companions in the Humvee.


"I want to know if I killed that guy yesterday," Hall says. "I saw blood spurt from his leg, but I want to be sure I killed him."

The vehicle goes silent as the driver, Spc. Joshua Dubois, swerves around asphalt previously uprooted by a blast.

"I'm confused about how I should feel about killing," says Dubois, who has a toddler back home. "The first time I shot someone, it was the most exhilarating thing I'd ever felt."

Dubois turns back to the road. "We talk about killing all the time," he says. "I never used to talk this way. I'm not proud of it, but it's like I can't stop. I'm worried what I will be like when I get home."

The men aren't Special Forces soldiers. They're troops with the Army's 2nd Armored Cavalry Regiment serving their 14th month in Iraq, much of it in daily battles. In 20 minutes, they will come under attack again.

Suicide in the Army

By the numbers

24 U.S. soldiers deployed to Iraq and Kuwait killed themselves last year, a rate of 17.3 per 100,000

All but two were male and almost two-thirds were unmarried

The annual Army average suicide rate is 11.9 per 100,000

The average suicide rate for civilian males ages 20 to 34, the common ages of those serving in the military, is 21.5 per 100,000

All but one died of gunshot wounds; the other from an overdose of over-the-counter medication

None had a history of mental-health treatment

Source: Department of Defense

Many soldiers and Army psychiatrists say these constant conversations about death help troops come to grips with the trauma of combat. But mental-health professionals within and outside the military point to the chatter as evidence of preventable anguish.

Soldiers are untrained, some experts say, for the trauma of killing. Forty years after lessons learned about combat stress in Vietnam, experts charge that avoidable psychological damage goes unchecked because military officials don't include emotional preparation in basic training.

The danger back home

Troops, returning home with untreated and little-understood mental-health issues, put themselves and their families at risk for suicide and domestic violence, experts say.

Twenty-four U.S. troops deployed to Iraq and Kuwait killed themselves last year, according to the Defense Department, an unusually high number, one official acknowledged.

On patrol, however, all that is available is talk.

"Kill, kill, kill, kill, kill," Hall says. "It's like it pounds at my brain. I'll figure out how to deal with it when I get home."

Home is the wrong place for soldiers to deal with combat experiences, some experts say.

"It's complete negligence," says Lt. Col. Dave Grossman, a retired psychology instructor at West Point who trains law-enforcement officers and special-operations soldiers.

"The military could train soldiers to talk about killing as easily as they train them to pull the trigger. But commanders are in denial. Nobody wants to accept the blame for a soldier who comes home a wreck for doing what his country asked him to do," he says.

The emotional and psychological ramifications of killing are mostly unstudied by the military, defense officials acknowledge.

U.S. soldiers practice an assault outside Najaf in April. Although troops are trained for combat, they aren't prepared for the trauma of killing.

"The idea and experience of killing another person is not addressed in military training," says Col. Thomas Burke, director of mental-health policy for the Defense Department. "Training's intent is to re-create battle, to make it an automatic behavior among soldiers."

He defends the approach, saying that if troops think too much about emotional issues in combat, it could undermine their effectiveness in battle.

Other military representatives, including officers overseeing combat stress-control programs, did not return repeated phone calls seeking comment.

Killing made automatic

Much of the military's research on killing and battle stress began after World War II, when studies revealed that only a small number of troops — as few as 15 percent — fired at adversaries in battles.

Military studies suggested troops were unexpectedly reluctant to kill. Military training methods changed, Grossman and others say, to make killing a more automatic behavior.

Bull's-eye targets used in basic training were replaced with objects shaped like humans. Battlefield conditions were reproduced more accurately, Burke says. The goal of these and other modifications was to help soldiers react more automatically.

The changes were effective. In the Vietnam War, 95 percent of combat troops shot at hostile fighters, according to military studies.


Veterans of the Vietnam War also suffered some of the highest levels of psychological damage. Possibly up to 50 percent of combat forces incurred mental injury, says Rachel MacNair, an expert on veteran psychology. Most notable among the injuries was post-traumatic stress disorder (PTSD), a condition contributing to violent outbursts years after soldiers leave battlefields.



"The more soldiers ignore their emotions and behave like trained machines rather than thinking people, the more you invite PTSD," says Dr. David Spiegel of the Stanford University School of Medicine.

But after returning home, veterans of the Iraq conflict are eschewing treatment for stress-related illnesses, according to a study out this summer.

Almost one in every six troops arriving home from duty in Iraq is showing symptoms of PTSD, depression or anxiety, but few have sought help, according to interviews with more than 6,000 soldiers and Marines before and after deployment.

According to the study in the New England Journal of Medicine, the veterans cited fear of the stigma of mental illness: that it could cost them their careers or alter relationships with peers and command officers. The study was led by Dr. Charles Hoge, chief of psychiatry and behavioral sciences at the Walter Reed Army Institute of Research.

"These findings cry out for creative solutions," says Dr. Matthew Friedman, executive director of the Department of Veterans Affairs National Center for PTSD. "We need to figure out ways to get these people into treatment."

PTSD was the most reported mental-health problem. Overall, about 12 percent of those returning from Iraq reported symptoms, compared with 3 to 4 percent of the general population.

Rachel Yehuda, director of the PTSD program at the Bronx Veterans Administration Hospital, says the consequences for soldiers seeking treatment are real "and the challenge is for the military to create an environment where mental health becomes part of the landscape."

Conflicting demands

Military officials say there have been changes in treating psychological trauma since Vietnam.

Foremost is the creation of combat stress-control teams: mental-health professionals in Iraq who speak with troops immediately after traumatic events, such as a U.S. casualty.

Military psychologists say immediate intervention is important. "We get them to voice what they are feeling, to realize they're not the odd man out, not to blame themselves," says Capt. Robert Cardona, a psychiatrist with a combat stress-control team based in southern Iraq.

But the demands of the military's mission and a soldier's mental health are sometimes at odds. "Our primary goal is to keep soldiers functional, so they can continue to fight," Cardona says. "Everything else, including feeling well, is second to that."

Mental-health technicians are available for troops who request help, Cardona says, but stress teams aren't deployed to bases just because U.S. forces kill hostile fighters. He says about half of the soldiers seeking help are traumatized because they killed someone.

"Killing unleashes emotions few people are prepared to deal with," Cardona says. "We help soldiers put those emotions and experiences away, so they can go into battle the next day. We set the expectation that shock is temporary and that they will return to duty."

Hugs — and hate



The men of the 2nd Armored Cavalry Regiment's Alpha and Charlie companies are resting and playing cards in the shade of a staircase, and talk turns to killing.

"I enjoy killing Iraqis," says Staff Sgt. William Deaton, 30, who had killed a hostile fighter the night before. Deaton has lost a good friend in Iraq. "I just feel rage, hate when I'm out there. I feel like I carry it all the time. We talk about it. We all feel the same way."

Sgt. Cleveland Rogers, 25, avoids dwelling on his actions.

"The other day an Iraqi guy was hit real bad, he was gonna die within an hour, but he was still alive and he started saying, 'Baby, baby,' telling me he has a kid," Rogers says. "I mentioned it to my guys after the mission. It doesn't bother me. It can't bother me. If it was the other way around, I'm sure it wouldn't bother him."

Spc. Nathan Borlee tries to keep a lid on what he's feeling.

"I feel like I'd lose control if I think about it too much, so I don't," the 23-year-old says. "Usually, everybody comes back and just gives everybody a hug. You kind of get overwhelmed by the feelings."

Without the proper training, experts say, these conversations may contribute to mental injuries.

Grossman, the retired West Point instructor, says training troops to have therapeutic discussions about killing is "not that hard." His curriculum, used by law-enforcement officers and after such traumas as school shootings, focuses on mental and physical techniques to manage anxiety and other emotional reactions to killing.

"To make killing instinctual, rather than conscious, is inviting pathological, destructive behavior," Grossman says. "We have to give soldiers a vocabulary to talk through emotions and teach them not to be embarrassed by troubling feelings."

"I worry about my soul"

Back in the Humvee, Hall and Dubois approach an abandoned elementary school that commanders say is hiding mortars and hostile fighters. Suddenly, the ground is punctuated by the yellow bursts of improvised explosive devices.

Hall begins firing his .50-caliber machine gun, the phosphorus on each fifth bullet trailing long, red streaks.

The constantly squawking radio pauses briefly and a calm, transmitted voice fills the truck.

"Enemy contact," the radio broadcasts. "Kill 'em, kill 'em."

Ahead, a tank pushes a hole through the school's wall. Staff Sgt. Robert McBride, 35, enters a classroom and sees a group of six Iraqis with guns, he later recounts. He throws a grenade. The blast cuts one Iraqi in half, and the rest lie dying. The soldiers collect dozens of mortar rounds and return to their vehicles. McBride looks at the hostile fighters once more.

"It did not bother me at all to see those bodies up close," McBride says later. "I'm a warrior. ... My soldiers, they are all warriors. They have no problems. I don't let them have problems. There is no place in this Army for men who aren't warriors."

The men's commander, however, worries about them.



"During the heat of the battle, the adrenaline is such you don't really think about it," says Capt. Brandon Payne, 28. "Once that adrenaline wears off, though, it gets tough. Some kids, it rolls right off their backs. Some, it's like they break down a little more each day."

Payne is as conflicted as his troops about making sense of war. Reconciling duty with ethics, he says, seems more complicated in Iraq.

"I'm a Christian. I feel I'm saving my soldiers' lives by destroying as many enemies as I can. But at the end of each day, I pray to God. I worry about my soul," he says. "Every time a door slams, I flinch. I'm hoping it will just go away when I get home."


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