Army treats combat stress in the field

KIRKUK, IRAQ -- Sgt. Seth "Doc" Musikant could be a recruiting poster for the Army's new approach to PTSD, post-traumatic stress disorder.

In April, Musikant and his team were driving around a traffic circle in the city of Tuz. It was their second time through the roundabout that day, and between trips somebody had planted a homemade bomb. It blew up their Humvee.

One of his comrades was killed, and three were wounded. In the frenzy that followed, Musikant handed his M-4 rifle to the Iraqi interpreter, screaming, "Pull security!" Then Doc, a medic, scrambled to treat the wounded.

Musikant, with the 3rd Battalion, 6th Field Artillery of the 10th Mountain Division's 1st Combat Brigade, was on his second tour in Iraq. Although he thought that he'd proved he had guts during his first tour, in Baghdad in 2005, the incident in Tuz bothered him. "It's like there's an invisible wall," Musikant said about the anxiety that temporarily troubled him.

He went to see the brigade's main mental health officer, Maj. Kyle Bourque.

"I told him it was bothering me," the 23-year-old former art student recalled. "I literally walked away with scratches. He said not to keep it inside, gave me some Ambien [a sleep aid]. I still don't talk about it with anybody I don't know."

Never has the U.S. military been forced to confront so much of "the battle behind the battle" -- the psychic and emotional wounds of war. What's more, grunts no longer bear the brunt of such attacks; thanks to suicide bombers and homemade bombs, drivers, cooks and other rear-echelon troops have also been killed and wounded.

A recent Rand Corp. study (criticized by the military for relying on too small a sample), calculated that about 300,000 out of 1.6 million veterans of Iraq and Afghanistan have suffered some sort of PTSD or TBI, traumatic brain injury.

Never has the military faced such sharp criticism for its handling, or mishandling, of the mental well-being of its troops. But never before have commanders and their troops dealt with the problems and the stigma of PTSD more directly than they've begun doing in Iraq and Afghanistan.

For one thing, it's cheaper to treat PTSD than it is to train a new recruit. For another, Bourque said, "the healthier their personnel, the better off the Army is."

Now the Army identifies a condition called acute stress reaction, or ASR -- the immediate aftermath of a traumatic incident in a combat zone. Since PTSD takes months, sometimes years, to manifest itself, military doctors and counselors prefer the new term to describe what they regard as normal reactions among troops confronted by abnormal situations.

Last year, the Army launched a mandatory training program to identify and treat the causes and symptoms of PTSD. The Pentagon no longer treats visits to a counselor as an adverse factor in giving security clearances.

What the 10th Mountain's 1st Brigade Combat Team has been doing for the past 11 months in Kirkuk province offers an inside look at how a gung-ho, gun-slinging outfit is dealing with the toll its troops cannot see.

Commander felt it

Because its commander, Col. David Paschal, one month into this tour, had to deal with the deaths of four of his personal security detail, the 3,500-strong 1st Brigade is probably more proactive about the problems posed by PTSD than many of its Army counterparts.

Its troops generally agree that during this tour, much more is being done for soldiers gripped by nightmares, flashbacks, survivor's guilt, apprehension and thoughts of suicide.

"The command has zero tolerance for blowing off a soldier's concerns," said Sgt. 1st Class Keven Duncan, who was wounded in Baghdad during his unit's 2005 tour.