IS THE Iraq war another Vietnam? The debate will run and run, but on one level at least the answer is clear. The psychological damage done to American soldiers in Iraq is as bad, in terms of the proportion affected and the degree of harm, as anything Vietnam veterans endured.
We have known about post-traumatic stress disorder for decades. Sufferers experience flashbacks, emotional detachment, rage, sleeplessness and depression. There are hints that people who develop it as a result of intense and persistent trauma can end up with a dramatically reduced hippocampus, a part of the brain critical to memory. Now we know something else about this illness that should give presidents and prime ministers pause for thought before they send soldiers to the front: PTSD induced by direct combat is a lot more debilitating than we thought, with sufferers more likely to die of heart disease and cancer later in life (see 鈥淭rauma of war hits troops years later鈥�). It seems stress hormones are the trigger: there is something especially deadly about the stress induced by face-to-face fighting, ambushes, roadside bombings and other aspects of close battle that typified Vietnam and now Iraq.
All too often politicians have been allowed to skate over the appalling reality of close combat when taking the decision to go to war. When George Bush and Tony Blair sent their armies into Iraq, they commended the brave men and women going out to fight in the name of freedom and security, but they spoke nothing of the realities of war and the long-term, debilitating effects on those who take up arms. Such considerations hardly figure in public debate 鈥� although this has begun to change, at least in the US, where a pair of recent shootings involving Iraq veterans made national headlines.
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It is imperative that such things are discussed, and that the full cost of war is openly considered. There is still much we do not understand. It is not clear, for example, what it is about close-up combat that makes it so especially traumatic 鈥� the fear of being injured or dying, the horror at seeing comrades injured or killed, the physical exhaustion, the distress at handling dead bodies or the revulsion and guilt at having to kill. No one should underestimate the psychological impact of killing an enemy. Throughout history and especially since the start of the second world war, researchers have documented how soldiers will often go to great lengths to avoid firing directly at enemy soldiers, especially if they can see them 鈥� and the distress they suffer when they do kill.
A famous example is the Battle of Gettysburg, where thousands of soldiers on both sides loaded their weapons over and over to avoid having to fire them. Similarly during the second world war, S. L. A. Marshall, a US army historian, found that on average only 15 to 20 per cent of American infantry troops actually fired at the enemy when they had the opportunity to do so. There is disagreement over his precise figures, but the conclusion is plain: most soldiers have a strong aversion to killing.
鈥淪oldiers will often go to great lengths to avoid firing directly at enemy soldiers, especially if they can see them鈥�
Modern armies have developed ways of overcoming this reticence, such as training soldiers to view the enemy as inhuman, and conditioning them to shoot on impulse. In the Korean and Vietnam wars the US firing rate was a lot higher than in the second world war. Clearly, many more American soldiers today are persuaded to do one of the most stressful and traumatic things imaginable. The question is: at what price to their psychological health?
Now the answer is becoming clearer, soldiers returning from the front should be given all the mental support they need 鈥� and the onus should not be on them to seek help, which can still carry a social stigma. They didn鈥檛 get the support after Vietnam; worse, they had to endure social condemnation when they got home. British and American Iraq veterans are also not getting the support, and if the national mood turns against the war they could be just as vulnerable.
It is a common assumption that soldiers who go to war are just doing their job, end of story. The trouble is, that isn鈥檛 the end of the story, it is only the start: PTSD can disable people for the rest of their lives and exact a heavy toll on their family and society. Governments have two options. One is to give soldiers all the help they need when they return 鈥� something they have spectacularly failed to do so far. The other option is not to send them at all.
