Stresses of battle hit female GIs hard Print E-mail
Forwarded by Leslie Radford

Stresses of battle hit female GIs hard

VA study hopes to find treatment for disorder
By Kirsten Scharnberg
Tribune national correspondent
March 20, 2005

NEW YORK -- On a mission just south of Baghdad over the winter, a young
soldier jumped into the gunner's turret of an armored Humvee and took
control of the menacing .50-caliber machine gun. She was 19 years old,
weighed barely 100 pounds and had a blond ponytail hanging out from under
her Kevlar helmet.

"This is what is different about this war," Lt. Col. Richard Rael, commander
of the 515th Corps Support Battalion, said of the scene at the time. "Women
are fighting it. Women under my command have confirmed kills. These little
wisps of things are stronger than anyone could ever imagine and taking on
more than most Americans could ever know."

But today, two years after the start of an Iraq war in which traditional
front lines were virtually obliterated and women were tasked to fill lethal
combat roles more routinely than in any conflict in U.S. history, the nation
may be just beginning to see and feel the effects of such service.

Thousands of women, like the male veterans of so many wars before, are
returning home emotionally damaged by what they have seen and done. These
female troops appear more prone to post-traumatic stress disorder, or PTSD,
than their male counterparts.

And studies indicate that many of these women suffer from more pronounced
and debilitating forms of PTSD than men, a worrisome finding in a nation
that remembers how many traumatized troops got back from Vietnam and turned
to drugs and violence, alcohol and suicide.

One children's book increasingly popular among military families illustrates
what the effects of this most recent war might mean for society in the years
and even decades to come: "Why Is Mommy Like She Is? A Book for Kids About

In the wake of such concerns, the Veterans Affairs Department has launched a
pioneering $6 million study of PTSD among female veterans. It is the first
VA study to focus exclusively on female veterans; 8 percent to 10 percent of
active-duty and retired military women suffer from 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.

According to Schnurr, data 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, speaking of the nearly 216,000 U.S. women on active duty
and the nearly 151,000 who are part of the reserves and National Guard.

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."

MacNair, however, focuses on another factor that she believes more acutely
affects the rate of PTSD among veterans of Iraq: whether they have killed
during their deployment.

In 1999, MacNair earned her doctorate at the University of Missouri-Kansas
City with a study that analyzed the data from the National Vietnam Veterans
Readjustment Study, a landmark congressionally funded project that studied
nearly 1,700 veterans.

Her findings were stark: Troops who had killed--or believed they had
killed--suffered significantly higher rates of PTSD than those who had not.

"It is very clear that being shot at is traumatic, or losing your buddy is
traumatic, but the act of shooting and killing another human being,
something that goes against every instinct we have, is the biggest trauma of
all," said MacNair, who calls this kind of PTSD "perpetration-induced
traumatic stress."

That hypothesis by MacNair, who is strongly critical of the military, is
supported by history and by military experts.

S.L.A. Marshall, one of the earlier official Army historians, estimated
after studying World War II veterans that only 15 percent had fired their
weapons during battle. He asserted from his interviews with soldiers that
their failure in battle was because they were more afraid of killing than of
being killed. Other studies show that even the most poorly treated prisoners
of war had lower rates of PTSD than front-line soldiers because the
prisoners no longer were in a position where they had to kill.

How such findings translate to the Iraq war is clear. Unlike previous
conflicts, where women rarely were pulling the triggers or running the
weaponry that left enemies dead on the battlefield, they routinely are doing
so in Iraq, as Lt. Col. Rael pointed out on that cold December day on the
outskirts of Baghdad.

On top of that they are being taken prisoner, as was Pvt. Jessica Lynch
during the initial invasion; they, like their male counterparts, are being
constantly mortared and ambushed by a guerrilla insurgency; and they are
watching fellow troops go home grievously wounded or dead in numbers not
seen since the war in Vietnam.

Killing `tips the scales'

"It all adds up," said MacNair, "but the act of having killed does seem to
be the factor that tips the scales in favor of PTSD."

Of the nearly 245,000 veterans returning from Iraq and Afghanistan, almost
12,500 have been to VA counseling centers for readjustment problems and
symptoms of PTSD. In addition, a study in The New England Journal of
Medicine found that up to 17 percent of troops returning from Iraq were
suffering from PTSD or other readjustment problems.

So far no statistics have been released detailing how many of these patients
are women, but numerous support groups have sprung up specifically for women
with PTSD. In one Internet chat group, Sisters Bound by Honor, women
struggling with PTSD talk with one another about their experiences.

Yet the women who most need counseling to help them deal with what they
witnessed in Iraq and Afghanistan--like their male counterparts--are the
most unlikely to seek it.

A Defense Department study of combat troops returning from Iraq found that
soldiers and Marines deeply suffering from PTSD and readjustment problems
were not likely to seek help because of the stigma such an act might carry.
In the study, 1 in 6 veterans acknowledged symptoms of severe depression and
PTSD, but 6 in 10 of the same veterans feared their commanders and fellow
troops would treat them differently and lose confidence in them if they
sought treatment for their problems.

That seems especially true of women, who have fought for years to be
assigned positions in the Army that once were off-limits to them. A number
of female Iraq war veterans suffering from PTSD declined to be interviewed
for this article.

Alert to early need

Still, former Army Lt. Col. Dave Grossman, who taught psychology at West
Point and wrote the book "On Killing," which closely documented the link
between killing and PTSD, believes the treatment of PTSD among the veterans
of Iraq could be the most effective in combat history. Using an analogy to
obesity, he said that after past wars, only those traumatized soldiers "who
were 400 pounds overweight got attention or treatment."

"But now," Grossman said, "we are so sensitive to PTSD and its effects that
we can notice the person who is the equivalent of just 20 or so pounds
overweight, and we can help them then, long before they have the psychiatric
equivalent of high blood pressure and heart attack."

The study of female veterans suffering from PTSD may be just such a start.
The study includes hundreds of women and aims, among other things, to
discover which clinical treatments are most effective for women with the

Half of the women will be treated through prolonged exposure therapy, in
which each woman will be guided for 10 weeks through vivid remembering of
the traumatic event or events until her emotional response decreases through
"habituation." Schnurr, one of the study's directors, compares habituation
to the way city dwellers grow immune over time to loud noises such as police
sirens or car alarms.

"The goal is that the memory of the traumatic event is no longer as
startling, as terrifying, when it comes," she said.

The other half of the women will be treated with what is known as
"present-centered therapy," a treatment that focuses on helping a patient
deal with her current life challenges rather than the memory of past traumas.

"Both therapies are appropriate and helpful to some degree," Schnurr said,
"but we expect that the prolonged exposure will be the most effective. If
that is the case, I think we will begin using that treatment much more--and
more effectively--in the years to come."

Although the goal of the study is to determine which therapies work best for
women suffering from PTSD, experts agree that if the study is conclusive it
eventually may be applied to tens of thousands of Iraq war veterans, male
and female alike.

"It is our hope that we can find ways to help these women," Schnurr said.
"But, more than that, we are hoping to draw some conclusions that can help
us in the treatment of PTSD across the board. That means men and women,
soldiers and Marines, those who are suffering for reasons having nothing to
do with combat at all."

Copyright (c) 2005, Chicago Tribune