Stress Epidemic Strikes American Forces in Iraq
By Peter Beaumont
The Observer
Sunday 25 January 2004

The war's over, but the suicide rate is high and the army is riddled with acute psychiatric problems. 

Up to one in five of the American military personnel in Iraq will suffer from post-traumatic stress disorder, say senior forces' medical staff dealing with the psychiatric fallout of the war. 

This revelation follows the disclosure last month that more than 600 US servicemen and women have been evacuated from the country for psychiatric reasons since the conflict started last March. 

At least 22 US soldiers have killed themselves - a rate considered abnormally high - mostly since President George Bush declared an end to major combat on 1 May last year, These suicides have led to a high-level Department of Defence investigation, details of which will be disclosed in the next few weeks. 

Although the overall suicide rate is running at an average of 13.5 per 100,000 troops, compared with a US army average of 10.5 to 11 per 100,000 in recent years, the incidence of the vast majority of suicides in the period after 1 May is statistically significant, accounting for about 7 per cent of all service deaths in Iraq. 

The same, say experts, is true for psychiatric evacuations, the majority of which have taken place after that date, a fact confirmed in recent interviews by Colonel Theodore Nam, chief of in-patient psychiatry services at the Walter Reed Army Medical Centre in Washington. He says no psychiatric cases at all were evacuated during the major combat. High levels of psychiatric casualties are expected, despite the US armed forces making an unprecedented effort to deal with stress and psychiatric disorders during service in Iraq. 

At the heart of the concern is that Iraq may repeat the experience of Vietnam, which experienced low levels of psychiatric problems during service there in comparison with the two world wars, but very high levels of post-traumatic stress disorder (PTSD) among veterans later. 

According to Captain Jennifer Berg, the chairman of psychiatric services at the Naval Medical Centre in San Diego, whose staff see US Marines returning from Iraq, military psychiatrists have been warned to expect the disorder to occur in 20 per cent of the servicemen and women in Iraq. 

Although Berg believes some of the problems already reported - including the suicides and psychiatric evacuations - relate to people's experiences during the invasion rather than its aftermath, she concedes that the forces' present conditions of service in Iraq are producing their own problems. 

'I think during the combat phase there was a huge outpouring of support at home. The soldiers were also trained and ramped up for their mission. There has been a change since then. There is a feeling among troops there that they have fallen off the public screen. And the longer people are there, the more we are seeing people come forward with stress reactions.' 

Berg believes operating conditions for the 'nation-building phase' of the Iraq campaign are creating their own kinds of mental health problems - not least the ever-present threat to US vehicles and troops of the resistance's home-made mines. These are one of the main causes of death among coalition troops in the period after 1 May. 

'In comparison with the combat phase, what we are now seeing are conditions of chronic stress which the troops are experiencing every day. It is a combination of danger, boredom and sleep deprivation, and the knowledge that they are a long way from home,' said Berg. 'In addition people are no longer sure when or what the end will be. No one knows when they will be going home. They are also working in an environment where the people they came to help are very hostile.' 

Already the cases that such doctors as Berg are seeing have what she describes as 'classic reactions, the basic symptoms of combat stress'. 

The psychiatrists have seen symptoms ranging from disturbed sleep, heart palpitations, nausea and diarrhoea to more obvious behavioural problems, such as forgetful-ness, aggression, irrational anger and feelings of alienation. 

From the present period of chronic stress to the personnel, the doctors are expecting symptoms of depression and generalised anxiety to develop. These may be exacerbated by underlying existing traumas. The most pronounced cases have already ended in suicide. 

Among them was Army Specialist Joseph Suell, who wrote a last letter home to his mother before he died of an overdose of the painkiller Tylenol on 16 June. Suell complained to her of the conditions he was living in, without electricity, water to bathe in, as well as a fear that he would be killed by an Iraqi sniper. 

He complained how badly he missed his wife and daughters during a year-long posting to South Korea before he was sent to Kuwait and then on to Iraq. He had been granted compassionate leave. 

As he prepared for war it was clear to his family he was in trouble, his worried wife even intervening to try to secure his return. 

Suell's is one of the few suicides to have been reported in the American media. The Pentagon has refused to say which of its 'non-hostile fatalities' have been self-inflicted. 

The military psychiatrists are puzzled by the suicide rate in Iraq, saying that it makes little sense in comparison with those in past conflicts. 

The accepted wisdom in military psychiatry is that the level of suicides - far from increasing during wars - drops as the survival instinct kicks in among the personnel in the conflict zone. Just two suicides were recorded among US personnel during the entire Gulf war in the Nineties. What is also unusual about the rate in Iraq, in comparison with Vietnam, Korea and the Second World War, is that everyone serving in the all-volunteer forces has already been screened for their psychological suitability. They have also been briefed on combat stress and trained to counter any suicidal feelings, following a rash of military suicides which embarrassed the Pentagon in the late Nineties.