# Shell shock: the invisible scar from the trenches to the Gulf



## daftandbarmy (23 Apr 2007)

Grim account of the human cost of Iraq.  Echoes of Ernest Hemingway's quote from 70 years ago when writing about the Spanish Civil War, "Never think that war, however necessary, is not a crime.  Ask the dead; ask the infantry."


From The Times
April 20, 2007

Shell shock: the invisible scar from the trenches to the Gulf
US troops are fighting a high-tech war. Yet, as in the mud of the Somme, soldiers are suffering from the effects of fear and bombs
Roger Boyes in Landstuhl 
The front line is only a few hours away and there is still sand stuck to their desert boots as the wounded are lowered on to the waiting trolleys. “OK, next one is coming out feet first,” shouts a nursing sister, as yet another American soldier is rolled out of a Blue Bird ambulance bus. The chaplain glances at his clipboard, leans forward and says: “You’re safe now Billy, you’re in Landstuhl.” 

A liaison officer, wearing an armband that says “Caring for Heroes”, places a “wounded warrior’s pack” next to his feet, sees that one of the patient’s legs is missing and places it a bit higher. Tubes and electric cables form a mess of high-tech spaghetti around Billy’s naked torso. 

Billy does not look well but then none of today’s deliveries from Iraq is in good shape, not even the infantryman who, according to the dispatch documents, has been removed from the battlefield because of acute diarrhoea. It has been a five-hour flight from Iraq to Ramstein airbase, then an ambulance drive to the biggest American military hospital in Europe. Many of the casualties were hit only 24 hours earlier, the C-17 transporter is the equivalent of the bumpy First World War field ambulance and they are drained and dazed. 

The figures are contested but more than 3,300 American troops have been killed and almost 25,000 wounded in this war. Those wounded in Iraq (or just simply ill, since the American presence is now the equivalent of a medium-sized town) and Afghanistan have first to come through Landstuhl, a sprawling clinical compound close to the French border that was designed as a Hitler Youth campus. Landstuhl, nestled in a lush valley, is as verdant and as sleepy as Fallujah is dusty and noisy; the chokepoint of a controversial war. 

Every day the wounded are wheeled in — 23 on the first day that we were there; 39 the next — and always there is the same nervous buzz among the waiting medical staff. Even the lowliest of orderlies has come to understand that the treatment of the wounded is the way in which a country measures its performance in war. When the standards of Walter Reed in Washington were criticised recently there was an immediate impact on frontline troops. It also stirred public distaste for the management of the war. 

But what if the most lasting wounds are invisible and therefore immeasurable? All the signs are that the sustained war is creating a mental health problem in the American military — the modern equivalent of “shell shock”, a combination of post-traumatic stress disorder, which induces a continuing state of anxiety, and traumatic brain injury (TBI), that may have several physical symptoms. 

“Six hundred of the soldiers that came here from Iraq last year had mental health conditions,” says Lieutenant-Colonel Gary Southwell, chief psychologist at Landstuhl, “and 20 per cent of them were suffering from post-traumatic stress syndrome — flashbacks, hypervigilance, memory loss. One of the major reasons people are being sent home is self-destructiveness, suicidal thoughts.” 

Lance Corporal Yahiel Sanchez drove over a booby-trap bomb on Friday the 13th and the nurses are telling the 19-year-old Puerto Rican that he was a lucky man. “I was blown out of our gun-truck,” says the Marine. “I hit the ground and a friend dragged me to the cover of a cleared house.” While the battle with the insurgents raged on, Corporal Sanchez had his clothes ripped off, his broken leg was splinted and when a medical squad arrived they smashed down a door to make an improvised stretcher. It was an exemplary case of field medicine. Yet the young Marine’s answers are fuzzy, his eyes unfocused; his memory of the incident is precise but everything else around him seems to be in a fog. 

“We can spot some TBI sufferers straight away,” says Lieutenant-Colonel Stephen Flaherty, the chief surgeon who has helped to pioneer a brain-screening system. “They can’t find their way to the dining facilities. Weeks on, they could be still reading maps upside down.” 

Since last May the physically injured passing through Landstuhl have been given a brain scan: moderate and severe TBI can be spotted, but the mild variation does not show up. So a nurse waits patiently to see Corporal Sanchez and ask him to recite the months of the year backwards or to recall the first five words of their conversation. “We have developed a points system that has been tried out on contact sport athletes, football players mainly, who have suffered concussion,” says Colonel Flaherty. About 60 per cent of troops who survive bomb blasts — the top cause of death — could have brain injury. 

Again and again in the wards and the corridors of the American hospital, we meet people whose injuries are little different from those suffered in the First World War. The face of Sergeant Derek Whittaker creases in pain as his physiotherapist persuades him to stand up for the first time since his vehicle was blown up. As he rises from the bed, he leaves a sheet that has turned magenta from lost blood. A big chunk of bone is missing from his leg. 

“I can’t do it,” he gasps, blenched by the effort, and shamed by the admission of defeat. He is 28, nine months in Iraq with an army transport unit; an old man in a young man’s war. Conceding failure comes hard. Lying down again, he covers his face. “Headache?” asks his doctor, Lieutenant-Commander Kathy Vaydaghs. He grunts. A waiting nurse ticks her TBI question box. 

There is no collective memory in the US, as there is in the British Army, of soldierly experience in previous wars: of trench warfare in 1915, of desert campaigning in the Second World War, of the long Northern Ireland operations. The American textbooks are written by Vietnam veterans. The mental health experts have, however, been mugging up on the First World War: the overlapping symptoms of TBI and post-traumatic stress disorder bear a remarkable resemblance to the shell shock suffered, sometimes for decades, by survivors of the Somme. The combination of noise, fear and pain overloads the brain. 

“Above all, the problem is fatigue,” says Colonel Southwell. He has just returned from a year in Iraq and knows that 12 months’ service is a real psychological steam. “Six months would be optimal, but that is not possible in this war.” Now, as part of the Administration’s “surge”, combat service is to be extended to 15 months. Colonel Southwell hesitates before saying: “We do worry about this.” 

So how modern is this war? Post-traumatic stress disorder was a condition diagnosed after returning Vietnam veterans went off the rails. Gulf War syndrome has been used to explain the extraordinary physical and mental symptoms of often distraught soldiers. But TBI has been defined actually in the midst of a counter- insurgent war and as a result it carries little of the stigma attached to the shell-shocked, locked away in British asylums in the 1920s. 

“We have regular conferring — audio with Iraq and Afghanistan, video with Walter Reed — to track the development of a TBI case,” says Colonel Flaherty. The Congressional Research Service estimates that twice as many soldiers are being treated for brain injuries as for amputations. 

“We really need the Government to step up,” says John Melia, executive director of the Wounded Warrior Project. 

“If this country cannot serve severely injured men and women coming back from this conflict, we need to look at ourselves. Unfortunately, to this point we have failed.” That stamps the Iraq mission as a modern war, not a rehash of Vietnam or the Somme. 

It can be measured in the number of soldiers who express a genuine desire to return to combat after being treated for sometimes horrific injuries. 

Lance Corporal Kimani Boyea, 19, is an easygoing Marine from North Carolina, who had most of the left side of his face ripped out while serving as a gunner in a convoy protecting his commander. Now, with more than 100 stitches holding his face together, he is on his way back to his unit. “My mother cussed me out, she said, ‘like, why are you goin’ out there again?’,” says Corporal Boyea. “But this is my decision.” Hospital psychiatrists say that soldiers feel guilty about leaving their comrades behind. 

The modern world has changed war not just in terms of firepower, intelligence and medication but also in the everyday lot of the soldier who can phone home regularly to discuss his daughter’s school report or the slow progress in renovating the kitchen. This could be a double-edged benefit, bringing home tensions “downrange” (as the US forces describe Iraq). 

To be 19, to have been brought up on painless video game warfare and Tarantino films, to go to war in a strange land, be blown up and lose a bucket of blood, and want to return — that requires courage but also a suspension of normal fears and anxieties. It is the numbing down of war. 

But stray a few corridors away from the hospital’s Burger King canteen and you end up in the intensive care unit and return to the gritty reality of war. “I saw 23 die in the ICU,” says a chaplain, Erik Harp. “Then I quit counting. One night a soldier called for me and said, ‘I’m going straight to Hell’.” The soldier told the chaplain he had killed 37 Iraqis. “They killed my buddies, I killed them and I found joy in it.” The chaplain told the dying man that God’s grace was infinite. The man continued to scream: “I’m going to Hell!” 

“Is war ugly?” asks the Mormon minister. “It is.” 

Casualties of war

3,312 US military personnel have died in Iraq since March 20, 2003 

26,188 have been injured up to February 3 this year 

19.1% of troops returning from Iraq report mental health problems, compared with 11.3% from Afghanistan and 8.5% from other theatres 

27,886 of the 146,000 US troops serving in Iraq would eventually require psychological help if that rate continued 

4% of troops suffer posttraumatic stress disorder after a month in Iraq, rising to 12% after seven months 

4.4% are depressed after a month, rising to 9% at seven months 

90% of casualties in Iraq survive, compared with 69.7% in the Second World War and 76.4% in Vietnam 

20% of survivors have serious head or spinal injuries, and another 6% are amputees 

Sources: healthday.com; Journal of American Medical Association; medscape.com; dodd.senate.gov; icasualties.org; US Department of Defence

Nightmares and flashbacks

- Shell shock was the term used in the First World War for the mental disorientation that resulted from the constant noise and fear of artillery barrages in the trenches 

- About 1 in 20 Second World War veterans suffered from symptoms including flashbacks and nightmares 

- More than half of all male Vietnam veterans, and almost half of all female Vietnam veterans — about 1,700,000 in total — experienced “clinically serious stress reaction symptoms” 

- A third of male Vietnam veterans and a quarter of females are afflicted by of post-traumatic stress disorder for life 

- The US Department of Defence reported 1,179 traumatic brain injuries sustained in Iraq up to March last year, of which 222 were classed “severe” or “penetrating” 

Sources: US Department of Veterans Affairs; Federation of American Scientists


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## medaid (24 Apr 2007)

I am at a loss for words after reading that. We ask so much from our men and women, yet we do so little for them once they return. Forgive me when I say I am slightly critical of the American war in Iraq. I am not critical of the soldiers, who are my brothers and sisters in arms, despite the geographical difference. I am critical of the politicians, who drive the brave men and women to their impending doom everyday. 

I understood the day that I became an officer, that I would one day make a harsh and very real decision which could send my troops into harms way. However, I thank (insert deity here) everyday that I am not a combat arms soldier, because I don't know IF I could make that kind of decision everyday in theatre. I am not saying whether this is the case, because I have not been there, I have not done that, and I will not pretend that I have. However, from my point of view, at times we do way too little for our soldiers that return from theatre.

I am well aware of the services that we provide for out soldiers when they return back home. A nice decompression period, and access to counselling if they seek it. But I still feel as if we are merely tossing them aside, and letting them fend for themselves. It seems like human nature to be grateful for a short while, then that gratitude slowly fades and eventually it disappears. A grateful nation sometimes is only grateful until the next story runs on the news. 

We take from our soldiers, their youth, their energy, their love for their home, their country and their families. 
We take from their hearts, their souls and their dreams.
We leave them with almost nothing.
There are some of us who are so despicable that they even take our soldiers' cause, the reasons why they fought for us and abuse it to its fullest. 

Maybe it is time for our people, for us, to stop taking and start giving back to those soldiers who have fought so hard to keep us safe. Show our appreciation for their sacrifice and loss by saying 'Thank You'.

Stop and talk to a veteran the next time you seem them. Listen to their stories. Like daftandbarmy's post says, the injuries have not changed, but neither has the story of friendships and camaraderie.


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## daftandbarmy (28 Apr 2007)

More tales from the front. Doesn't sound too rosy for Thomas Atkins either... thanks mainly to the Iranians no doubt


The Independent
Serving British soldier exposes horror of war in 'crazy' Basra By Terri Judd
Published: 27 April 2007
A British soldier has broken ranks within days of returning from Iraq to speak publicly of the horror of his tour of duty there, painting a picture of troops under siege, "sitting ducks" to an increasingly sophisticated insurgency. 

"Basra is lost, they are in control now. It's a full-scale riot and the Government are just trying to save face," said Private Paul Barton.

The 27-year-old, who returned from his second tour of Iraq this week along with other members of 1st Battalion, the Staffordshire Regiment, insisted that he remains loyal to the Army despite such public dissent. He said he had already volunteered to go to Afghanistan later this year.

But, he said, he felt strongly that somebody had to speak out: "I want people to see it as it is; not the sugar-coated version."

His public protest is a sign of the groundswell of anger among the troops, and predictions that more will come forward to break the traditional covenant of silent service. Just last month, Pte Steve Baldwin, 22, a soldier in the same regiment, spoke to The Independent about the way he had been "pushed aside" since being injured by a roadside bomb which killed three others during the Staffords' first tour of Iraq in 2005.

And on Monday, Cpl Richard Bradley also chose to air his views on
television: "Blokes are dying for no cause at all and blokes are getting injured for no cause at all."

Reacting to Pte Barton's comments, many soldiers on websites appeared stunned but in agreement. One said: "When I arrived back last year, I was utterly depressed by what I had seen out there and the lack of any progress ... any journo sticking a microphone in my grid would have been given enough soundbites to retire on. And I would probably be in the Tower of London.

"I can only imagine that the situation 12 months on is even worse, and it would not surprise me if this is repeated over the coming months by more guys coming back from their third and fourth tours to that midden."

Pte Barton felt so strongly that he telephoned his local paper, the Tamworth Herald, to speak of the "side you don't hear".

The regiment lost one soldier, Pte Johnathon Wysoczan, 21, during its tour, but 33 more were injured. "I was the first one to get to one of the tents after it was hit, where one of my mates was in bed. The top of his head and his hand was blown off. He is now brain damaged.

"We were losing people and didn't have enough to replace them. You hear about the fatalities but not the injuries. We have had four who got shot in the arm, a bloke got blown up twice by roadside bombs and shot in the neck and survived."

Most, he said, endured at least one "lucky escape" during their tour. "I had a grenade chucked at me by practically a five-year-old kid. I had a mortar land a couple of metres from me."

The regiment was based in the Shatt al-Arab hotel base, which was handed over to the Iraqi army on 8 April. Of the 40 tents in the base, just five remained unscathed by the end of the tour, he said. "We were just sitting ducks ... On the last tour we were not mortared very often. This tour, it was two to three times a day. Fifteen mortars and three rockets were fired at us in the first hour we were there."

He added: "Towards the end of January to March, it was like a siege mentality. We were getting mortared every hour of the day. We were constantly being fired at. We basically didn't sleep for six months. You couldn't rest. Psychologically, it wore you down.

"Every patrol we went on we were either shot at or blown up by roadside bombs. It was crazy."

He insisted that the insurgents appeared to be considerably better trained, funded and equipped than had been the case during their first tour of duty.

"Last tour, I never fired my rifle once. This time, I fired 127 rounds on five different occasions. And, in my role [providing medical support], I shouldn't have to fire." He added: "We have overstayed our welcome now. We should speed up the withdrawal. It's a lost battle. We should pull out and call it quits."


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## proudnurse (28 Apr 2007)

I am very moved by this thread, and MedTech your response as well. Having being close to a Combat Veteran that served in Iraq, and still being close to him for a short time after his return, I am at a loss for words as I read this too. I think it's very important, that articles such as these are shared. Hopefully in bringing some understanding, so that we may learn and never forget what our Soldiers have gone through and are going through. In that, I hope many can learn, so that we may be able to help our friends and loved ones when they return from Theatre. 

God Bless ~ Rebecca


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