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Service Members' Experiences in Iraq and Afganistan

The consideration of Service Members’ experiences in the theater of war is a far more complex process than one would assume.  In the words of one veteran interviewee, “War is the best and the worst that humanity has to offer.  It has periods of satisfaction and heroism, and periods of the most grotesque and unimaginable experiences.  The trick for the war veteran is to be able to negotiate that experience(Steve Robinson, Veteran and Consultant, ONE Freedom).

Variations in Experience:  Returning veterans’ experiences in Iraq and Afghanistan are many and varied, depending on a number of factors that might include:

  • When they were deployed (with the likelihood of lower exposure to violence among many Service Members who were not deployed until after the troop Surge that began in 2007 was well underway)
  • Where they were deployed (with relative peace in some areas and higher levels of violence in others)
  • Strength of bonding and leadership within their Units (with stronger bonding and more motivational leadership cited as protective factors for combat stress and post-deployment stress effects)
  • How many tours of duty they served, how long those tours lasted, and the length of time between tours (with multiple tours, longer tours, and shorter “reset” time cited as major risk factors for post-deployment effects)
  • Their roles in the war zone (from combat to nation building)
  • How often those roles took them “outside the wire” that surrounds the relative safety of the forward operating base (FOB)
  • Where they happened to be when the mortar sailed in or the improvised explosive device (IED) exploded
  • How much time they spent in situations of threat and helplessness, situations in which there truly was no way to predict, control, or take action against enemy attacks

Urban Warfare:  Henderson (2006) noted that technological advances now make it possible to fight 24 hours a day, leaving no built-in “down-time” to decompress and return stress systems to balance.  He also cited the special nature of urban warfare, which:

  • Tends to go on for long periods of time, with no clear front line
  • Increases the chance of accidentally killing the wrong people
  • Brings attacks in out of anywhere, at any time, from anyone
  • Uses up supplies at a faster rate, straining supply lines and leading to shortages
  • Makes it difficult to enforce even clear rules of engagement
  • Does not leave time to grieve losses
  • Makes it more likely that one will accidentally inflict casualties on civilians

In the words of Padin-Rivera (2006), “Much of the violence has no uniform.  Any civilians can be dangerous.  Everything is a possible weapon” (Padin-Rivera, 2006, p. 10).

Conditions in the War Zone:  The Department of Veterans Affairs (2004) provided a comprehensive list of conditions under which Service Members operate, including the following.

Chronic high levels of discomfort:

  • Intense heat
  • Austere living conditions, unpleasant living quarters
  • Heavy physical demands
  • Sleep deprivation
  • Periods of intense violence followed by unpredictable periods of relative inactivity
  • Lack of enjoyable food, lack of privacy
  • Cultural difficulties, boredom, inadequate equipment, long workdays
  • Separation from loved ones
  • Concerns about life at home (family, job, relationships, significant events)
  • Sexual or gender harassment
  • Racial or cultural prejudice, discrimination, or harassment

Disruption and confusion:

  • Operational plans that change constantly
  • Unclear knowledge of enemy capabilities
  • Equipment that breaks down
  • Uncertain supply lines
  • Rules of engagement that change regularly as political and tactical requirements change
  • The need to make split decisions
  • Disruption of the environment

The realities of combat:

  • Physical injury
  • Threat of death or injury
  • Witnessing the death, wounding, and disfigurement of friends, enemies, and civilians (including children)
  • The sights, sounds, and smells of dying men, women, and children
  • Handling or removing the remains of civilians, enemy combatants, US and allied service members, and animals
  • Working with prisoners of war
  • Seeing devastated communities and homeless refugees

The realities of an insurgency war:

  • Terrorist activities and guerilla warfare (car bombs, IED, mortar attacks) lead to chronic strain and anxiety
  • Insurgency may lead Service Members to question the purpose, importance, and need for such sacrifices
  • Anyone can be carrying a firearm, explosive, or remote detonation device
  • If a vehicle challenges a roadblock or security checkpoint, delay may lead a to loss of friendly forces, but a premature response may kill innocent civilians
  • Friendly-fire events are among the most tragic and the most difficult to reconstruct in autobiographical memory, leading to lower levels of integration and greater potential for unchecked activity in procedural memory

Stress-system responses to these conditions:

  • Intense emotion and sensory exposure
  • Heightened levels of arousal
  • Intrusive recollections
  • Symptoms of dissociation
  • Fear, rage, or helplessness
  • Attempts to avoid emotion (VA, 2004)

Sleep Deprivation and Fatigue:  According to the Army’s Mental Health Advisory Team’s 2006 report, “...a considerable number of Soldiers and Marines are conducting combat operations every day of the week, 10-12 hours per day seven days a week for months on end.  At no time in our military history have Soldiers or Marines been required to serve on the front line in any war for a period of 6-7 months, let alone years, without a significant break in order to recover from the physical, psychological, and emotional demands that ensue from combat” (MHAT, 2006, p. 76).

One Iraq war veteran interviewee reported experiencing a lack of restorative sleep, sometimes for days, weeks, or months, with perhaps one hour’s shallow sleep each night.  Contributors to sleep deprivation can include constant mortar attacks, sleeping (or attempting to sleep) in a truck, “24/7” military duties, and sleeping on high alert (Armstrong, Best, and Domenici, 2006).  Sleep deprivation reduces blood flow to the brain, increasing the likelihood of a number of neurological challenges, including depression (Amen, 2008).

According to Scaer and colleagues (2008), the physical fatigue associated with carrying large quantities of supplies and protective gear can also add to the risk of post-deployment stress effects.  Carrying 80-100 pounds of body armor and gear often leads to chronic contraction of anterior (front) core muscles (e.g., the psoas muscles that extend from the lower spine over the pelvis and hip—the very muscles involved in the dissociative “freeze” response.  This may play a role in storing trauma in the body’s procedural memory (Scaer et al., 2008).

The need for rapid redeployment also tends to compound both the fatigue and the risk.  According to the Mental Health Advisory Team, “We know from findings from the Walter Reed Army Institute of Research (WRAIR) Land Combat Study that the mental health status of Soldiers has not ‘re-set’ after returning from combat duty in Iraq and before they are applied again to Iraq” (MHAT, 2006, p. 77).

Military Sexual Trauma:  The Iraq War Clinicians Guide describes military sexual trauma as including both sexual harassment and sexual assault in military settings.  It can happen to either gender, and the perpetrator can be of the opposite or the same gender.  It generally occurs within the Unit, a closed community in which there is little privacy and the victim and perpetrator must meet on a regular basis (VA, 2004).  According to Lighthall (2008), military sexual trauma can have devastating effects throughout the Unit and throughout Service Members’ stress systems, because it shatters the Unit cohesion that is so essential to survival and resilience (Lighthall, 2008).

Effects of the Surge:  Given the relative decrease in violence during the troop Surge that began in Iraq in Summer, 2007 (Farrell and Oppel, 2008), one might hope that the level of post-deployment stress effects would have decreased as well during that time.  OIF veterans interviewed have expressed both their hope and their doubts that this is true, given that:

  • Lower levels of violence can reduce the intense levels of the post-deployment stress responses that tend to follow the worst periods of combat.
  • Even though the incidence of violence has decreased, the potential for violence still exists, and it is this potential that activates constant hyperarousal of stress and survival systems.
  • Post-deployment stress effects are not “healed” by later reductions in violence or threat, but can remain in the body for years until they are addressed with effective therapy and/or re-balancing measures.

The Iraq War Clinician Guide also notes that even light or minimal exposure to violence can engender post deployment effects:  “… clinicians need to be careful not to minimize reports of light or minimal exposure to combat.  They should bear in mind that in civilian life, for example, a person could suffer from chronic PTSD as a result of a single, isolated life-threat experience (such as a physical assault or motor vehicle accident)” (VA, 2004, p. 25).

Next: Positive Experiences in the Theater of War


The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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