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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