What causes stress among soldiers in war?

People keep asking me what happens psychologically to a person like POW Jessica Lynch. At the time of this writing it is known that she suffered some physical abuse by an Iraqi guard. Physical abuse, torture, and sexual assault may also have occurred, and will certainly happen to other POWs.

Military veterans are one of the largest studied populations in psychology. Studying reactions to combat has provided invaluable information about how we all react to trauma. War can be particularly traumatizing because of the multitude of traumas that are experienced.

One's life is at stake. One can witness violence, death, and other mayhem on large scales. Multiple losses of friends and comrades can occur. And, one may not only be the victim of violence, but perpetuate injury and killing of other people, also very traumatizing. As one Vietnam veteran once told me, "I could deal with being shot, what haunted me was the killing that I did."

The term "shell shock" or "combat fatigue" developed after WWI when many veterans returned with similar psychological symptoms. Because of these veterans' psychological reactions, the government hired psychiatric hospitals to recruit and train hundreds of psychiatric residents to treat veterans returning from WWII. Later, the Vietnam War led to about 30 percent of military personnel experiencing trauma symptoms.

Today, there are over 100 VA hospitals in the country with mental health personnel trained in treating war trauma. In the last 30 years research about child abuse and rape has revealed that these victims experience similar symptoms to war veterans.

The term Post Traumatic Stress Disorder (PTSD) was coined to encompass the reactions people experience when traumatized. Basically, symptoms of PTSD include nightmares, flashbacks of traumatic events, feeling emotionally "numb" and then experiencing intense anxiety or anger, being "spaced out," avoiding situations that remind you of your trauma, excessive guilt, and physical symptoms.

Those exposed to war violence can develop full-blown PTSD or some of its symptoms. Just as no two people are alike, no two people experience or express trauma in the same way. And, not all people exposed to war violence get PTSD. Why? In essence, trauma is like drinking alcohol: the more alcohol you drink the more intoxicated you become. The same is true for trauma. For instance, if a soldier experienced childhood abuse or other traumas, he or she is more likely to suffer PTSD from war experiences. And, soldiers are more at risk the more they are exposed to war violence. POWs and those on the front lines are particularly at risk because of the intensity and frequency of the violence. Genetic predispositions and pre-existing personality also contribute. An ability to communicate about the trauma immediately after it occurs lessens trauma symptoms. Combat readiness helps prepare military personnel for trauma and the social support in combat life can be protective.

How does PTSD "happen" to the body? The following is a very simplified explanation of a very complicated system. Essentially, a small area of the brain called the amygdala coordinates the body's circuit involved in responding to anxiety and fear. Our body is made to expect some trauma and is equipped to react with the fight or flight response. When attacked, the brain produces large amounts of hormones that prepare the body to respond in some way, cortisol is one of these key hormones. These hormones act as the body's natural opiates which can temporarily mask pain. During times of stress cortisol levels rise and then subside as stress subsides.

If stress is profound or chronic the cortisol levels stay high and the person is left feeling over-anxious much of the time. Eventually this circuit can "burn out" leaving the person feeling numb. High levels of cortisol also overwhelm the hippocampus, a part of our brain that converts sensory experiences into enduring memories. The brain tends to store traumatic memories visually, so when the anxiety circuit is triggered again these visual memories pop into focus, producing flashbacks and nightmares.

Our bodies have a memory, so when veterans are in situations that remind them of past combat, their bodies automatically react as they did during the original trauma. This is why veterans of previous wars tend to become more emotionally "shaky" during subsequent military action; they are being retraumatized by memories of war.

The good news is that the military is aware of these problems, and VA centers across the country help people suffering after combat. Research shows that soldiers returning to a strong support system do much better than those who are isolated. Soldiers who talk about what happened to them, and do so frequently, also do much better. Talking about trauma helps organize the brain and lessens trauma being stored in visual memory. This is why therapy can be very successful in treating PTSD.

Non-combat military personnel in WWII and in the Vietnam War experienced nearly as high amounts of PTSD as did those in direct combat. They were traumatized by their exposure to the soldiers' trauma. Keeping this in mind, it is interesting to think about how we all may be traumatized by the graphic images of war that are available to us on television and in newspapers. While not as serious as those in combat, war can be traumatizing to everyone. Remember that talking about your feelings and thoughts on the war is important because it provides a context for you to organize your own experiences of the war.

Lisa Keating, Ph.D., is a Carson City clinical psychologist.