Women in Combat: Females and PTSD

According to the Department of Defense (DoD), 11% of those serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are women. Officially, they are restricted to non-combat roles; however, in wars such as that being waged in Iraq, there are no front lines. Combat roles or not -- they are in the thick of things.

Last week, the Chicago Tribune covered how war has lingered with some of the women returning home. I'll round things out by reposting a related January commentary of mine which appeared online before PTSD Combat was up and running.

In educational interest, article(s) quoted from extensively.

From the Chicago Tribune:

Keri Christensen spots an empty pop can on the side of the road in McHenry County, and in a flash she is back at the helm of a heavy-equipment transporter maneuvering along Iraq's treacherous highways. Her two children are strapped into seats in her mini-van, but Christensen finds herself scrutinizing roadside trash for signs of a makeshift bomb. "Everything is weird," said Christensen, 33, a Wisconsin National Guard soldier who returned in November to the Chicago area after serving 10 months in Iraq. "I went from a stay-at-home mom to a soldier instantly."

Traveling that path in reverse has been equally tough for Christensen and a rising tide of other female veterans. Since 2003, the number of former soldiers seeking help for combat-related post-traumatic stress disorder has grown so much that the North Chicago Veterans Affairs Medical Center has shifted its women's mental health program to respond to combat stress disorders.

Formed in 2001, the program was originally geared to help women suffering trauma from sexual harassment to rape. The program still helps women with what the Armed Forces calls "military sexual trauma." But therapists now are seeing female vets who exhibit the same signs of post-traumatic stress disorder as men who served in infantry units. "Flashbacks, hyper-vigilance, sleep disorders. They're always on edge," said Katherine Dong, manager of the Women Veterans Health Care Program at the North Chicago facility, who helped form the mental health program. "If somebody drops a book, they hit the floor."

A higher percentage of women returning from the combat zone seek help for symptoms associated with PTSD. This could point to female troops having a greater likelihood of suffering emotional damage following traumatic experiences or they may be more willing than men to reach out for help.

"There are all these roadside bombs," said Barb Wisott, a former social worker at the North Chicago hospital who recently moved to the VA's Eastern Colorado Health Care System in Denver. "Women driving in convoys and delivering supplies are experiencing more combat exposure."

Though the symptoms are similar in both men and women--nightmares, flashbacks, a fear of crowds, irritability--more women than men are coming home to fulfill the role of primary nurturer. A growing number are finding the transition from soldier to mom difficult, vets and veterans administrators say. "Women are often trying to reintegrate into a family with young children," Dong said. "They're expected to go back to being with the kids."

For Christensen, that part of her homecoming was especially hard. Sobbing at silly things like patriotic songs on a country radio station was frustrating enough. It was worse to do it in front of her children, Madison, 7, and Olivia, 4. "I'd try to hold it together in front of the kids," she said.

Between 2002 and 2006, about 20,000 men and 6,000 women were diagnosed with mental health issues, including 2,500 women assessed specifically with post-trauma stress, according to VA data. But officials caution that the numbers likely represent a fraction of those who suffer from the stress disorder, since only about 10 percent of veterans seek medical help at VA hospitals. Some go to private clinics; others may not seek help at all.

Those who seek treatment often need help functioning in day-to-day tasks, such as raising children, going to work, even going to the store. Elaine Rosado of Chicago, a single mom and Army Reserve staff sergeant who drove 18-wheelers across Iraq, needed help keeping her temper under control.

Before her deployment she had been easygoing and happy, she said. When she got home, she found herself snapping easily at her son, Issac, 4. It wasn't until her mother mentioned her behavior that Rosado, 25, realized she was acting out of character. Talking with a therapist helped. "I'll still snap," she said. "But now I'll catch myself."

Christensen worked tirelessly to keep from feeling like she was slipping. She cleaned obsessively, filling trash bins with old junk from the basement. "I have a totally purged house," she said. She cried for no apparent reason, considered suicide and once had what seemed to her a real conversation with her husband, Brian, while he was upstairs sleeping. "I thought, `Oh my God, I'm going crazy. I'm hallucinating,'" Christensen said. "I didn't want to go anywhere. I was afraid to drive with the kids in the car. I'd wait until my husband got home to run errands."

In Iraq, Christensen endured roadside bombs, small-arms fire or grenades on every mission she made. And she was assigned the heartbreaking task of working at a port in Kuwait through which soldiers' caskets passed. "They'd have the name and date of birth on them," she said. "You'd think, `God, these kids are so young.'"

No Going Back

"If you tried to pull women out of the equation, this country could not fight a war." -- Lory Manning, a retired Navy captain and director of the Women's Research and Education Institute

Although women have served in one capacity or another in every major war in U.S. history, Iraq has easily become the largest deployment of women to a combat zone: one out of every seven is female. As their numbers have increased, so have their responsibilities. No longer relegated to being spies or nurses, they now find themselves in the heat of battle.

As Retired Air Force Brig. Gen. Wilma L. Vaught puts it:

"You've got more women carrying weapons with the possibility that they'll use them to fight or defend themselves," Vaught said in a phone interview. "That's one of the big differences between this war and others. Women haven't done this type of war before."

They are serving admirably and proving their metal daily. Because of the nature of the Iraq war, the policy preventing women from serving in combat positions doesn't shield them from stressful combat situations. For example, in the opening days of the war:

1st Lt. Adrien Thom prepared for the journey toward Baghdad.

It was the day before the ground offensive on the city and she would lead a platoon of 15 Marines on a support mission for advancing troops. The mission required that she travel alongside ground combat divisions; a move that was against Marine Corps policies that prohibit women from participating in direct ground combat operations. But Thom said her commander told her to go ahead and that she was just as capable as any man.

Thom, a 26-year-old combat engineer from Louisiana, sat in the passenger seat of the front truck, a map in one hand, a phone in the other and a radio next to her as the convoy rolled past burning buses, abandoned military vehicles, big pits of burning oil. ... During the next few days, frequent fire fights broke out between Iraqi insurgents and the combat Marines with whom she stayed. Incoming mortar rounds could be heard from every direction. It was a chaotic scene.

Current federal law is meant to shield women from armed conflict. As such, females are technically banned from serving in any of the following groups:

infantry
tank, artillery and armored vehicle units
coastal patrol boats and submarines
special operations units such as Army Rangers and Navy SEALS

Althought President Bush has determinedly stated, "no women in combat," the Pentagon has begun relaxing their ban, placing women in more dangerous roles in the combat zone.

In February, the Army's 3rd Infantry Division acknowledged it has assigned women to units in Iraq that directly support combat troops by providing food, equipment maintenance and other services. The process, called "collocation" - literally to place side by side - is at odds with an 11-year-old Army policy that bans women from serving in front-line support groups.

"This is an incremental change that will gradually lead to a more direct deployment of women in combat," said Elaine Donnelly, president of the Center for Military Readiness.

Listen to an NPR interview with another female veteran's experience on the front lines here.

The First Female Casualty of War

Although the names Jessica Lynch and Soshanna Johnson are more commonly recognized in most homes across the country, their friend who perished that day in Nasiriyah is not. Army Private Lori Piestewa, the first female to lose her life in Iraq -- and the first Native American woman to die in combat on foreign soil -- has been mostly forgotten. When their support convoy wound up lost on the third day of the US invasion, it was picked off by Iraqi soldiers. The course error was fatal and costly: 11 American soldiers dead and nine wounded.

In the end, policy or no policy, women are in the thick of things, right along with our men. Of the ambush, the military later described it as a "torrent of fire" that had rained down on the unsuspecting unit of clerks, cooks, and repairmen. [For more on this incident, please read the excellent Rolling Stone piece, A Wrong Turn in the Desert by Osha Gray Davidson.]

Women and PTSD

PTSD affects women at twice the rate of men. Furthermore, studies show that their symptoms are more striking and incapacitating.
In a July 2005 article, Newsweek reported that:

20 years ago, only 2% of patients at VA hospitals were women
Today, 14% of VA patients are women
About 85,000 OEF and OIF vets have sought VA medical care
11% (9,688) have been diagnosed with PTSD (current figure: 16,000)
Of these 9,688 with PTSD, 1, 277 are women

To better understand how to successfully treat deployed women returning with combat-related PTSD, the VA has launched a first-ever $6 million study focusing on female veteran PTSD.

"PTSD is a very real problem for women who serve in the military," said Paula Schnurr, one of the study's lead researchers and the deputy executive director of the VA's National Center for PTSD in White River Junction, Vt. "This study is specifically addressing that, and we hope it will not only help us treat women coming home from Iraq, but all those who have ever served and struggled with PTSD in any conflict before."

The study's findings are not due until the end of the year, but researchers already have made some startling discoveries that are illustrative of the nature of PTSD among female veterans and of the U.S. military.

Male and female physiology being what is it, not surprisingly each has a unique way of coping with the demons they may have brought back with them from war.

Men, for example, are more prone to pick up drinking or drugs as a way of self-medicating themselves, attempting to numb their pain. Women, conversely, are more likely to seek help. This difference may be one reason for the larger percentage of women who have been identified suffering with PTSD; however it's not the only factor.

From a March, 2005 piece in the Chicago Tribune:

"[D]ata indicate that female military personnel are far more likely than their male counterparts to have been exposed to some kind of trauma or multiple traumas before joining the military or being deployed in combat. That may include physical assault, sexual abuse or rape.

The speculation is that many of them are joining the military to get away from adverse environments," said Schnurr, also a professor of psychiatry at Dartmouth College. ... The implication of such a finding on PTSD research is considered significant. Because most research indicates that a person is at greater risk of developing PTSD--or developing more severe PTSD--when he or she has had past traumas, many female troops are deploying to war zones already heavily predisposed to react adversely to the intense fear, killing and loss routinely encountered there.

"The evidence is conclusive," said Rachel MacNair, an expert in the psychological effects of violence and PTSD. "The greater the trauma in your life, the greater the symptoms of PTSD."

An additional factor that has some bearing on female veteran PTSD is the added reality of rape and sexual intimidation from her fellow troops. Since PTSD is slow to show itself, we have no way of knowing how grave a problem this will be for our soldiers, their families, their communities, and our nation.

Only time will tell.

Resources for Women Dealing with PTSD

To cope with PTSD, female soldiers have formed Internet support groups (MSN Group Sisters Bound by Honor, for example). They've also begun using a book on PTSD called Why Is Mommy Like She Is? to help them when they transition back to their children's lives after being deployed.

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