Help available to combat-weary warriors exiting Iraq

3 Sep 2004 | Lance Cpl. Samuel Bard Valliere 1st Marine Logistics Group

Some Marines who have served in Iraq for the last six months may be carrying extra baggage back to the United States in the form of combat stress.

Two Navy doctors who share a tiny office built into the backroom of the camp chapel, aim to keep the carry-ons to a minimum as the I Marine Expeditionary Force's deployed troops prepare to hop on planes and hand the reins of the Al Anbar Province over to another team of Marines.

It's not your typical psychiatrist's office. The classic black leather couch has been replaced by a floppy canvas camping chair, and the imposing walls in the cramped room are made of unfinished plywood.

A lot of talking goes on within those walls. The doctors help young men and women who are trained to use force as their voice during combat identify and cope with the stress of a war-time deployment.

Iraq has no shortage of stress for troops. The constant threat of attack during frequent all-night supply convoys puts support Marines, like those with the 1st Force Service Support Group on edge no matter how many miles they have covered on the highways here.

"Whether it's your first mission or your 100th, the stressors are the same," said Maj. Mark A. Lamelza, 36, the commanding officer of 3rd Battalion, 24th Marine Regiment's Weapons Company, which has helped provide security for some 1st FSSG convoys.

One mortar or roadside bomb attack can send a wave of emotion through a Marine that could last months, he added.

"You're shocked, and when that wears off, you're pissed at the unseen enemy lurking in the shadows," he said. "Many Marines see that as a dishonorable way to fight."

The "unseen enemy" can prowl in Marines' minds, also, if they aren't given a chance to recover.

Oftentimes a simple prescription of "three hots and a cot," and some time to decompress, is all it takes to relieve the stress, said Capt. William J. Hocter Jr., 44, a psychiatrist and one of the doctors.

The idea of giving troops time to take a break is nothing new.

Lamelza's company, for example, participates in an ongoing series of games, including kickball, flag football and volleyball, intended to give the reserve infantrymen a healthy outlet for their stress.

"The Marines aren't internalizing as much when they let it all out in the spirit of competition," he said.

The rotating cast of doctors here has seen about 190 patients since the I Marine Expeditionary Force replaced the Army's 82nd Airborne Division in Iraq in March 2004. Six patients were sent back to the states, but the doctors do everything they can to help without having to detach individuals from their unit, said Lt. Cmdr. Eric E. Cunha, 42, a clinical psychologist and the other half of the combat stress team.

Treating warriors without removing them from the war is also not a new practice. According to a Navy medical publication on combat stress, leaders learned during World War I that permanent mental injury was most often avoided when troops were treated near their unit.

According to Lamelza, that is to be expected, considering the close bonds Marines develop with their comrades.

"I've seen Marines go through a lot, and they want to stay with their unit because it's a big support group," he said. "There is no one better to take care of you than your brother Marines, because we are family."

In a culture where many wear their hearts in a sheath and a knife on their sleeve, few Marines look for the help needed after experiencing combat. In fact, according to Hocter, three-fourths don't seek treatment.

"Most of the time they are brought in or referred to us by a concerned person," said the native of Great Lakes, Ill.

One way the doctors identify people with possible problems is by holding post-deployment health assessments of troops headed home.

Navy corpsmen working for the doctors walk homeward bound troops through a series of questions about the state of their mental and physical health.

Certain questions in the brief are designed to help identify people who may want to talk to one of the doctors, said Hocter.

"About 1 percent of the people get flagged during the PDHA," he said. "They come to us and we either say, 'this is just a combat thing,' or something deeper."

Postponing an appointment could lead to more issues, said Hocter. The symptoms, like nightmares, depression, anxiety and flashbacks, build on each other and can gradually become worse.

"We expect them to be experiencing this a little bit, but when it's uncontrollable, it becomes a problem," said Cunha, a native of San Jose, Calif.

About half of the patient traffic that has moved through the office has been Army soldiers burdened with 13-month deployments, said Hocter.

Many of them are National Guardsmen who were forced to transition from part-time soldier to full-time warrior, leaving families and careers behind to work long hours in a dangerous environment.

Even active-duty Marines scheduled to rotate out after about six months are feeling the effects of extended, more dangerous work days.

Cpl. Tyson R. Cailteux, 25, a fire team leader with the 1st FSSG's Military Police Company, has lingering nightmares after numerous firefights and mortar attacks plagued the convoys he helped provide security for.

"We got hit one day and again the next, then we went over to Fallujah the next day and got hammered," he said, recalling a series of particularly bad days. "After a while it takes a toll."

He made his leaders aware of his dreams and was taken off convoy security missions. Since then, he said, the dreams have come less.

It helps, said Lamelza, to break up the workload and give troops an opportunity to relax between missions.

"We're running a lot of operations every day, so we're always looking to give Marines something to do to keep them fresh so they don't burn out," said Lamelza. "Balancing missions with welfare of Marines is something every command needs to do.

Many Marines are on their way out of Iraq now and being replaced by fresh faces. Before they leave, they also sit down in groups and listen to a brief given by a chaplain, who tells them what emotional changes they can expect upon returning and the best way to deal with what they have seen and been through.

Those new to Iraq also have the opportunity to talk to the doctors here and at other camps throughout Al Anbar at any time.

If unsettling memories from the deployment keep nagging at them even after veterans return home and settle back into everyday life, there are doctors available at Navy hospitals and through veterans programs in the states to help, said Cunha.
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