Hidden Scars of Battle

SUNGSU CHO / POLARIS FOR TIME
BATTLE WEARY The more fire fights a soldier faces, the greater the risk of the postwar disorder

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--Before deployment, the rate of PTSD in a sample of soldiers was 5%, about the same as it is for the American population in general (PTSD can be caused by sexual abuse, violent crime and other kinds of trauma). This is the first study to establish a base line for service members and should help resolve questions about whether they start out more psychologically fragile than other groups.

--The soldiers with the most symptoms were the ones who expressed the most qualms about seeking help and were the least likely to ask for treatment. They were worried about doing harm to their careers and to their reputations with commanders and comrades.

Service members in this study showed, on average, a somewhat higher rate of psychological damage than that seen in veterans of the Gulf War. But some experts are concerned that the figure may go higher still. "People in this survey were in the first part of the war, and the war has changed from a liberation campaign to a counterinsurgency effort," notes Dr. Matthew Friedman, executive director of the VA's National Center for PTSD. "The amount of uncertainty and traumatic exposure has increased." And as tours of duty are extended, Friedman points out, the risks only go up. Finally, the study did not look at any reservists or members of the National Guard, who tend to suffer higher rates of psychological damage than career Marines and soldiers, who are better trained and prepared for battle.

The good news is that PTSD can be successfully treated with a wide range of techniques including cognitive-behavioral therapy and drugs like Paxil and Zoloft. "The more immediate the intervention, the better, and the more likely that chronic problems can be avoided," says Dr. Ilan Kutz, an Israeli psychiatrist with extensive experience dealing with the disorder.

This is what makes the reluctance to be treated so tragic. Having learned hard lessons from Vietnam vets, the U.S. armed forces have beefed up efforts to provide psychological services to soldiers before, during and after combat. Castro hopes a new program providing free, confidential counseling from civilian therapists will appeal to those too ashamed to look for help within the military. (The hotline: 800-464-8107.) But his study shows there's more work to be done to counteract the stigma that keeps those most in need of aid from getting it.