Wounds That Don't Bleed

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Following deployment to Iraq, 17% of Army respondents and 19% of Marines reported a "perceived moderate or severe problem," according to a psychiatric study released last July by the Walter Reed Army Institute of Research. The study termed those estimates "conservative," and most cases, says Nash, will not be apparent until the troops are back home. The Marine who served in al-Anbar for seven months says that when he drives past potholes in his hometown, he wonders if they will explode. If the refrigerator door closes, he says, "I ask myself if that was incoming fire. A bomb?" And he's older than most grunts. "The younger guys--18, 19 years old — they're definitely going to have some challenges ahead," he adds. "God help somebody who pushes the wrong button on a kid who's been through these things."

Even the most battle-hardened troops report feeling symptoms like Harding's. They express anger, confusion and guilt about killing, guilt about surviving when a buddy doesn't. They confess to mood swings, depression, indifference to life, hypervigilance, isolation, suicidal tendencies. And all are plagued by images they can't forget, some so disturbing that combat-stress workers in the field have to monitor one another for a state known as "vicarious traumatization." A soldier deployed near Baghdad for nine months witnessed several members of his unit torn apart by mortar fire. "I can't erase that picture," he says. "It's something I cannot take anymore." Some stressed-out troops can't control their rage. "They don't know who the bad guy is," says Anthony Pantlitz, a chaplain with the Army's 785th Combat Stress Company, "so they hate everybody."

In the war zone, troops use a variety of means to try to stave off the aftershocks of trauma. Harding dealt with his anxieties by talking to other members of his company about them. Every time the events of that day ran though his mind, he said a prayer. He was reassured by visits from the battalion chaplain, who told the Marines to honor Halverson and their own good fortune by carrying on.

As an institution, the military tries to tend to what Major David Rabb of the 785th calls "the wounds that don't bleed." The military has mobilized mental-health units of psychiatrists, psychologists, occupational therapists, social workers, chaplains and nurses just behind the front lines. As the fighting has intensified over the past year, their number has increased. The goal, says Rabb, is "to let troops know they're not going crazy because they have some emotional and physical and psychological aftereffects of the traumatic events that they witnessed."

Rabb's company is based in Baghdad's green zone, in a two-room house with a volleyball net out front. When necessary, the house serves as a "restoration zone" where soldiers or Marines can spend three days "off line," getting rest and hot meals, talking through their problems. Similar sanctuaries exist on main bases throughout the country. In some instances, an antidepressant or antianxiety medication is prescribed. In extreme cases, the soldier or Marine is sent home. But the prime purpose is to prepare them to re-enter the fray, "healed" enough to undergo combat again. Rabb and other mental-health practitioners in Iraq say research from past wars shows that sending troubled troops home too early prevents them from dealing with their trauma and increases feelings of guilt stemming from a sense of abandoning the unit. Rabb won't quantify the number of combat-stress injuries incurred in Iraq. But he estimates that his team of counselors alone conducts up to 800 informal visits a month to troops in and around Baghdad, "just smoking and joking, letting them know we're available."