Every war leaves deep scars on its survivors, not least the soldiers who were involved.
In World War I there was "shell shock." World War II vets had "battle fatigue." The troubles of Vietnam veterans led to the codification of post-traumatic stress disorder. In combat, the fight-or-flight reflex floods the body with adrenaline, permitting impressive feats of speed and endurance. After spending weeks or months in this altered state, some soldiers cannot adjust to a peaceful setting. A visit to a crowded bank may become an ordeal. They display what doctors call "hypervigilance." They sit in restaurants with their backs to a wall. A car's backfire can transport them back to Baghdad.
The New York Times reported in December that a U.S. Army study notes that about one in six soldiers in Iraq report symptoms of major depression, serious anxiety or post-traumatic stress disorder, a proportion that some experts believe could eventually climb to one in three, the rate ultimately found in Vietnam veterans. Because about one million American troops have served so far in the conflicts in Iraq and Afghanistan, according to Pentagon figures, some experts predict that the number eventually requiring mental health treatment could exceed 100,000.
"There's a train coming that's packed with people who are going to need help for the next 35 years," said Stephen L. Robinson, a 20-year Army veteran who is now the executive director of the National Gulf War Resource Center, an advocacy group.
"I have a very strong sense that the mental health consequences are going to be the medical story of this war," said Dr. Stephen C. Joseph, who served as the Assistant Secretary of Defense for Health Affairs from 1994 to 1997.
Dr. Matthew J. Friedman, executive director of the Department of Veterans Affairs' National Center for Post-Traumatic Stress Disorder, said he believes the estimates are conservative. "I'm not an alarmist, but I think this is a serious problem. It may be worse just because of the nature of the war," he said, citing extended tours of duty and the change of mission from liberation to occupation.
"We're seeing an increasing number of guys with classic post-traumatic stress symptoms," said Dr. Evan Kanter, a psychiatrist at the Puget Sound Veterans Hospital in Seattle. "We're anxiously waiting for a flood that we expect is coming. And I feel stretched right now. Such costs of war are not revealed by official casualty counts. People see the figure of 1,200 dead. Rarely do they see the number of seriously wounded. Almost never do they hear about the psychiatric casualties."
Ninety percent of those posted to Iraq reported being shot at. A high percentage also reported killing an enemy combatant, or knowing someone who was injured or killed. About half said they had handled at least one dead body.
"In [Iraq's] urban terrain, the enemy is everywhere, across the street, in that window, up that alley," said Paul Rieckhoff, who served as a platoon leader with the Florida Army National Guard for ten months, going on hundreds of combat patrols around Baghdad. "It's a fishbowl. You never feel safe. You never relax." In his platoon of 38 people, eight were divorced while in Iraq or since they returned in February. One man in his 120-person company killed himself after coming home. "Too many guys are drinking," he said. "A lot have a hard time finding a job. I think the system is vastly under-prepared for the flood of mental health problems."
On his second day in Iraq, Staff Sgt. Georg-Andreas Pogany, a translator attached to the 10th Special Forces Group, suffered what he thought was a nervous breakdown after seeing one of the Iraqi dead. "I wasn't functioning. I was having physical symptoms. I was having a behavioral reaction," he recalled. After struggling through the night, he said he decided to tell his superior officer out of fear that "if we do go out on a patrol and I do freeze up, that could have consequences too." Instead of being given help, he was told to reconsider for the sake of his career. "The message was: 'Hey, you're a coward. You're acting like a coward.'" Pogany was sent back to the U.S. where he was charged with cowardice, though the charge has since been dropped. "My career is probably at an end. I've had my security clearance revoked. I'm still struggling to get things set straight." Pogany hopes that by speaking out he can help other veterans. "The most important thing is that trauma, whether experienced in combat or anywhere else in life, needs to be looked at as an injury to the mind. An injury to the mind needs to be treated just like an injury to the leg, whether you have shrapnel wounds or gunshot wounds."
Capt. Tim Wilson, an Army chaplain serving near Mosul, counsels up to ten soldiers a week for combat stress. He noted that fierce battles produce turbulent emotions. "There are usually two things they are dealing with," he said. "Either being shot at and not wanting to get shot at again, or after shooting someone, asking, 'Did I commit murder?' or 'Is God going to forgive me?' or 'How am I going to be when I get home?'"
"During the war, they don't have the leisure to focus on how they're feeling," said Dr. Sonja Batten, a psychologist at the Baltimore Veterans Hospital. "It's when they get back and find that their relationships are suffering and they can't hold down a job that they realize they have a problem."
Robert E. Brown, 35, was proud to be in the first wave of Marines invading Iraq last year, now finds himself in the first ranks of returning soldiers unhinged by what they experienced. He served for six months as a chaplain's assistant, counseling wounded soldiers, organizing makeshift memorial services and filling in on raids. He knew he was in trouble by the time he was on a ship home, when the sound of a hatch slamming would send him diving to the floor. After returning home, he began drinking heavily and saw his marriage fall apart. He was discharged and returned to his hometown, Peru, Indiana, where he slept for two weeks in his Ford Explorer, surrounded by mementos of the war. "I just couldn't stand to be with anybody," he said.
Dr. Batten started him on the road to recovery by giving his torment a name, an explanation and a treatment plan. But 18 months after leaving Iraq, he takes medication for depression and anxiety and returns in dreams to the horrors of war nearly every night. The scenes repeat in ghastly alternation, he says: the Iraqi girl, three or four years old, her skull torn open by a stray round; the Kuwaiti man imprisoned for 13 years by Saddam Hussein, cowering in madness and covered in waste; the young American soldier, desperate to escape the fighting, who sat in the latrine and fired his M-16 through his arm; the Iraqi missile speeding in as troops scramble in the dark for cover.
"That's the one that just stops my heart," said Brown. "I'm in my rack sleeping and there's a school bus full of explosives coming down at me and nowhere to go."
In July 2003, as Jeffrey Lucey, a Marine reservist from Belchertown, Massachusetts, prepared to leave Iraq after six months as a truck driver, he at first intended to report traumatic memories of seeing corpses, his parents, Kevin and Joyce Lucey, said. But when a supervisor suggested that such candor might delay his return home, Lucey played down his problems. Haunted by what he had seen, at home he spiraled downhill. He began to have delusions about having killed unarmed Iraqis. In June, at 23, he hanged himself in the basement of the family home.
"Other marines have verified to us that it is a subtle understanding which exists that if you want to go home you do not report any problems," Mr. Lucey's parents wrote in an e-mail message. "Jeff's perception, which is shared by others, is that to seek help is to admit that you are weak."
Meanwhile U.S. veterans from the war in Iraq are beginning to show up at homeless shelters around the country. Agencies assisting the homeless fear they are the leading edge of a new generation of homeless vets not seen since the Vietnam era. "We already have people from Iraq on the streets," said Linda Boone, director of the National Coalition for Homeless Veterans. "It's happening and this nation is not prepared for that."