07 July 2012

Forward Treatment of Combat Stress

On Killing by LtCol Dave Grossman, 2009, Excerpts

Treatment for these many manifestations of combat stress involves simply removing the soldier from the combat environment. The problem is that the military does not want to simply return the psychiatric casualty to normal life; it wants to return him to combat. And he is understandably reluctant to go. If soldiers begin to realize the insane soldiers are being evacuated, the number of psychiatric casualties will increase dramatically.

Proximity, or forward treatment, and expectancy are the principles developed to overcome the paradox of evacuation syndrome. These concepts, which have proved themselves quite effective since World War I, involve [1] treatment of the psychiatric casualty as far forward on the battlefield as possible, often inside enemy artillery range and [2] constant communication to the casualty by leadership and medical personnel of the expectancy that he will be rejoining his comrades in the front line as soon as possible. These two factors permit the psychiatric casualty to get treatment and much needed rest, while not giving a message to still-healthy comrades that psychiatric casualty is a ticket off the battlefield.

Military Field Hospital

Distressed soldiers treated at combat site
02 Aug 2010
Increasingly, the army is trying to treat traumatized soldiers “in theater” — where they’re stationed. The idea is that soldiers will heal best if kept with those who understand what they’ve been through, rather than being dumped into a treatment center back in the States where they’ll be surrounded by unfamiliar people and untethered from their work and routine.

However, the policy may serve the military at least as much as the soldiers. Treating soldiers on site makes it easier to send them back into battle — key for a stretched military fighting two wars. It also brings up a host of challenges: Ensuring soldiers get the treatment they need in the middle of war, monitoring those on antidepressants and sleeping pills, and deciding who can be kept in a war zone and who might snap.

Medicating soldiers in war brings up a host of difficulties not faced by doctors back in the States. Through trial and error, they’ve found that antidepressants help calm soldiers down enough to stay and finish their tours. “My mission here is to keep people on mission, keep people in the fight, keep people in the theater as opposed to having them air-evaced out,” Dr. Scholman said, the brigade psychiatrist. The most common drugs he prescribes are sleeping pills, followed by antidepressants. Often, he gives a soldier Prozac or Paxil to treat what he and his colleagues call “combat operational stress reaction.” The disorder — which is not formally recognized — includes symptoms like sleep problems, irritability and propensity to anger. Soldiers describe it as being “on edge, keyed up, jumpy, things like that,” he said.

Antidepressants take effect slowly, so soldiers usually don’t have to be taken out of their typical rotation of patrols and work. But some superior officers are still uneasy about soldiers fighting while on antidepressants. Sgt. Maj. Wilson was shocked by the idea that 50 of his soldiers could be on antidepressants and yet were not blocked from going outside the wire.

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