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Thursday, April 06, 2006

PTSD Statistics, WWII to Iraq

See also the comprehensive The War List: OEF/OIF Statistics.

Jack Epstein and Johnny Miller of the San Francisco Chronicle have done a great job of compiling statistics for shell shock, battle fatigue, and today's posttraumatic stress disorder from wars waged from WWII to Iraq.

Click on 'Article Link' below tags for a sample of Iraq stats...

[One note: A few stats are already outdated since this article's publication in June of 2005. Currently, according to the VA, 20,638 OEF/OIF troops have been diagnosed with PTSD.]

From the San Francisco Chronicle:

-- According to a 2005 VA study of 168,528 Iraqi veterans, 20 percent were diagnosed with psychological disorders, including 1,641 with PTSD.

-- In an earlier VA study this year, almost 12,500 of nearly 245,000 veterans visited VA counseling centers for readjustment problems and symptoms of PTSD.

-- The Marines and Army were nearly four times more likely to report PTSD than Navy or Air Force because of their greater exposure to combat situations.

-- Enlisted men were twice as likely as officers to report PTSD.

-- 8 percent to 10 percent of active-duty women and retired military women who served in Iraq suffer from PTSD.

-- Studies show that U.S. women serving in Iraq suffer from more pronounced and debilitating forms of PTSD than their male counterparts.

-- A Defense Department study of combat troops returning from Iraq found 1 in 6 soldiers and Marines acknowledged symptoms of severe depression and PTSD, and 6 in 10 of these same veterans were unlikely to seek help out of fear their commanders and fellow troops would treat them differently.

-- A 2003 study published in the New England Journal of Medicine said about 1 in 6 soldiers returning from Iraq suffered from PTSD. Interviews with those at risk showed that only 23 percent to 40 percent sought professional help, most typically because they feared it would hurt their military careers.

An updated study regarding the mental health of our current combat veterans was published in the Journal of the American Medical Association last month. Additional combat troop data can be found in the March 2006 issue of Esquire magazine, which I summarized here.

[UPDATE May 26, 2006]: The Waterloo/Cedar Falls [IA] Courier does another fine job of reporting on combat PTSD in a companion piece to this weekend's article detailing the unique characteristics of the Iraq war. This latest offering takes us on a quick history tour of PTSD through the years. Although each war has its own flavor, the only thing that's changed as far as the war's emotional aftershocks is what we decide to call the mental burdens placed on its veterans.

From the Courier:

Experts maintain the mental state as it relates to armed conflict likely began when the first human picked up the first stick or stone. Only the name has changed. During the Civil War, soldiers who lost their will or capacity to fight were afflicted with nostalgia, later diagnosed as soldier's heart. The affliction for a time also carried the name Swiss disease, a tribute to soldiers from that country forced into military units.

Society later introduced the concept of railway spine, which evolved from numerous and horrific railroad accidents. The diagnosis was popularized in lawsuits in the 1870s. As the theory evolved, doctors reached a general view that intense fear disturbed a person's nervous system. By the end of the 19th century, traumatic hysteria and traumatic neurasthenia were the accepted terms.

Then came World War I. The global cataclysm advanced the idea of subconscious mental processes, a theory gaining acceptance. During that war, physicians described soldiers as shell shocked. They assigned the diagnosis to those with neurological symptoms but no physical injuries. The term came from the idea exploding shells changed atmospheric pressure near soldiers, harming their nervous systems. Researchers later determined relatively few cases involved exploding ordnance, which only added to the mystery.

World War II provided the concept of combat fatigue. Statistics show one in four casualties in World War II resulted from the mental disorder. In Europe, the U.S. military recorded one combat stress casualty for every three soldiers wounded in action, according to Field Manual FM 6-22.5, which is used and distributed by the U.S. Marine Corps.

But it was the experience of Vietnam which eventually brought about the term posttraumatic stress disorder, recognized in the Diagnostic and Statistical Manual of Mental Disorders in 1980. In 1999, the DOD began to require the use of the term combat stress reaction; later it was changed to combat-operational stress reaction to show how it differed from other forms of trauma-induced PTSD.

Part of the disorder's history includes society's reaction to it. Whether diagnosed with nostalgia, railway spine or shell shock, afflicted soldiers over the years were labeled as malingerers. When he admitted problems about midway through a tour in Iraq, Army veteran Ron DeVoll Jr. of Cedar Falls says supervisors' attitudes changed. "They talked down to me, called me a coward. 'You're supposed to be tough. You're supposed to be a man.' I thought I was," he says.

In the course of seeking help, DeVoll told superiors he was having nightmares. "They said, 'That's normal. You'll get over it.'" The response DeVoll received in 2003 echoes that from earlier eras.

During World War I, Thomas Salmon, a U.S. medical officer, defined the condition as merely an "escape" from intolerable circumstances. At the same time, Fredrick Parsons, commanding officer at a U.S. military hospital, said "a war neurosis which persists is not a creditable disease to have ... as it indicates in practically every case a lack of the soldierly qualities which have distinguished the Allied Armies." He added "no one should be permitted to glorify himself as a case of 'shell shock.'"

During World War I, the British military reportedly executed more than 300 of its own soldiers for cowardice, desertion or insubordination. In today's terms, at least some likely were only demonstrating effects of combat-stress reaction.

In World War II, the British military described some of its soldiers as lacking moral fiber. On the American side, Gen. George Patton severely tarnished his distinguished military career after slapping and yelling at two soldiers. The privates were recuperating in a military hospital in Sicily alongside others with more visible wounds. "Don't admit this yellow bastard," Patton reportedly yelled at a medical officer. "There's nothing the matter with him. I won't have the hospitals cluttered up with these sons of bitches who haven't got the guts to fight."

President Franklin Roosevelt received hundreds of letters about the incident. The majority supported Patton and his actions; some even suggested a promotion was in order. Ultimately, though, Patton was reprimanded, ordered to apologize and relieved of command of the Seventh Army.

One of the best articles I've seen out there on the historical aspect of PTSD. Not surprising that it come from a local media source; they've been cleaning the clocks of the national media coverage on this for quite a while.


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