Wounds That Don't Bleed

By Phil Zabriskie

Full-scale offensives like Fallujah inevitably exact a psychic toll. Yet the punishing strain of fighting a hydra-headed insurgency afflicts U.S. troops even on what passes for a normal day in Iraq. Sergeant Justin Harding of the Ramadi-based 2nd Battalion, 5th Marines, can't get one of those October days out of his head. His squad, Reaper 2 of Whiskey Company, was heading back to base along one of Iraq's most dangerous roads. The squad's convoy, towing a vehicle disabled by a roadside bomb, was running at slow speed, making it vulnerable to ambush. Sure enough, an insurgent with a rocket-propelled-grenade (RPG) launcher, Harding recalls, "suddenly appeared, whirled around and pointed the RPG. And all hell broke loose." The grenade pierced the window of the armored humvee on the driver's side, engulfing the occupants in smoke, blood and shrapnel. Harding yelled at the driver, Lance Corporal Andrew Halverson, one day shy of his 20th birthday, to control the spinning vehicle. Then Harding looked over at him. "I saw his body. It wasn't normal. I instantly knew he was dead." The gunner, protected by a turret, was hit below the waist but still alive. The Marine in the seat behind Halverson was dazed, his legs on fire. But he managed to smother the flames and grab the steering wheel, bringing the battered vehicle to rest. "He was shaking and crying, just in shock," Harding says. "Bullets were flying everywhere." Harding quickly thrust the dead Marine into a body bag. "I didn't want the other Marines to see him because it would really freak everybody out," he says. "At the time, none of it fazed me. I was just doing what I had to do."

Yet once Harding returned to base, he had trouble sleeping. His mind replayed the gruesome scene over and over. He suffered changes of mood and was beset by anxiety about why the incident had happened. He went out on patrol the next day carrying with him classic symptoms of combat stress: the emotional, physical and psychological fallout from living through--or under the extended threat of--traumatic events. Said company commander Captain Patrick Rapicault, "You have to get over your feelings and keep on pushing, just for the simple reason that you have another 170 Marines to take care of and make sure they come back."

These days, stress is a given in Iraq for locals and foreigners working in just about any capacity. Combat troops no doubt feel it most acutely. Day after day in the hit-and-run, chase-and-hide rhythm that has defined most of the fighting over the past 20 months, front-line forces are confronting the bulk of the horrors. So far, more than 1,200 have died and at least 8,400 have sustained physical injuries. That does not count the 1 in 5 who, according to a recent study, are suffering what the military calls "stress injury."

It's easy to see why so many troops are succumbing to stress. Every trip "outside the wire" brings the possibility of attack from any direction, from people who look like everyday citizens and from everyday objects--cars, oilcans, dead animals, even human beings--refashioned into deadly bombs. "It's relentless," says a Marine who was deployed in al-Anbar province, which includes violent hotbeds like Ramadi and Fallujah. "From the moment you arrive until the moment you leave, you're in danger." The life-threatening character of the daily job steadily erodes an individual's psychological immune system.

"It makes everyone even more susceptible, less resilient, to whatever happens," says Navy Captain Bill Nash, a psychiatrist who heads the Marines' Operational Stress Control Readiness (OSCAR) program in al-Anbar. "The war here has produced more significant stress injuries than any other conflict since Vietnam," he says. "And you'd have to be exceptionally optimistic and using massive denial to believe we are not going to generate a hell of a lot more of these stress injuries before we are done here."

Following deployment to Iraq, 17% of Army respondents and 19% of Marines reported a "perceived moderate or severe problem," according to a psychiatric study released last July by the Walter Reed Army Institute of Research. The study termed those estimates "conservative," and most cases, says Nash, will not be apparent until the troops are back home. The Marine who served in al-Anbar for seven months says that when he drives past potholes in his hometown, he wonders if they will explode. If the refrigerator door closes, he says, "I ask myself if that was incoming fire. A bomb?" And he's older than most grunts. "The younger guys--18, 19 years old--they're definitely going to have some challenges ahead," he adds. "God help somebody who pushes the wrong button on a kid who's been through these things."

Even the most battle-hardened troops report feeling symptoms like Harding's. They express anger, confusion and guilt about killing, guilt about surviving when a buddy doesn't. They confess to mood swings, depression, indifference to life, hypervigilance, isolation, suicidal tendencies. And all are plagued by images they can't forget, some so disturbing that combat-stress workers in the field have to monitor one another for a state known as "vicarious traumatization." A soldier deployed near Baghdad for nine months witnessed several members of his unit torn apart by mortar fire. "I can't erase that picture," he says. "It's something I cannot take anymore." Some stressed-out troops can't control their rage. "They don't know who the bad guy is," says Anthony Pantlitz, a chaplain with the Army's 785th Combat Stress Company, "so they hate everybody."

In the war zone, troops use a variety of means to try to stave off the aftershocks of trauma. Harding dealt with his anxieties by talking to other members of his company about them. Every time the events of that day ran though his mind, he said a prayer. He was reassured by visits from the battalion chaplain, who told the Marines to honor Halverson and their own good fortune by carrying on.

As an institution, the military tries to tend to what Major David Rabb of the 785th calls "the wounds that don't bleed." The military has mobilized mental-health units of psychiatrists, psychologists, occupational therapists, social workers, chaplains and nurses just behind the front lines. As the fighting has intensified over the past year, their number has increased. The goal, says Rabb, is "to let troops know they're not going crazy because they have some emotional and physical and psychological aftereffects of the traumatic events that they witnessed."

Rabb's company is based in Baghdad's green zone, in a two-room house with a volleyball net out front. When necessary, the house serves as a "restoration zone" where soldiers or Marines can spend three days "off line," getting rest and hot meals, talking through their problems. Similar sanctuaries exist on main bases throughout the country. In some instances, an antidepressant or antianxiety medication is prescribed. In extreme cases, the soldier or Marine is sent home. But the prime purpose is to prepare them to re-enter the fray, "healed" enough to undergo combat again. Rabb and other mental-health practitioners in Iraq say research from past wars shows that sending troubled troops home too early prevents them from dealing with their trauma and increases feelings of guilt stemming from a sense of abandoning the unit. Rabb won't quantify the number of combat-stress injuries incurred in Iraq. But he estimates that his team of counselors alone conducts up to 800 informal visits a month to troops in and around Baghdad, "just smoking and joking, letting them know we're available."

Although that kind of support is resisted by many in the military who fear being stigmatized, it is gaining acceptance amid the tribulations of service in Iraq. Lieut. Troy Fiesel, a social worker with the 785th outfit, says the response has been "more than I expected. There have been guys I thought would never in 100 years, say, 'Hey, I need help.' We're seeing guys like this all the time."

Troops who don't use official services must find their own coping mechanisms, often within their unit. Leaders try to find downtime for their men, and memorial services for the fallen can help with grieving. But clinically speaking, Nash says, most soldiers and Marines engage in denial and dissociation to get through. "Everybody out here is putting all this stuff in a closet and storing it up," he says, "because you just can't deal with it right now."

Sergeant Harding agrees. "You can't dwell on it, or you can't do what you need to do," he said shortly after his unit returned from another firefight in town. Troops say the thing that most helps the traumatized is their commitment to one another. Their unit is the only thing they can trust, and helping one another get home safely is the most compelling motivation they have. A twice-wounded Whiskey Company Marine suffered two concussions in successive bombings and was told that a third could lead to severe, lasting damage. But when given the option of going home, he chose to stay because, he says, "these are my brothers. I feel safer with them than I do anywhere else. I need to be with them." As the Marine who served in al-Anbar earlier this year puts it, "All of the bigger issues don't exist. You understand, ultimately, that the mission is about protecting each other."

Whiskey Company faces that stress every day as it patrols the unsettled Sunni triangle. Last Monday, Rapicault and two other men in Whiskey Company died when a suicide bomber rammed their humvee while they were on patrol, raising to nine the number of Whiskey Company Marines killed in action since mid-September. "I'm taking it very hard," says medic Cory McFarland. "But their loss gives us more strength to move on." For many combatants in Iraq, that may be more a wish than a fact.