Two new articles provide graphic detail on a somewhat neglected aspect of war: the damage it enacts upon mental health. On Sunday, the New York Times Magazine had an article on American female soldiers suffering from post-traumatic stress disorder (PTSD). It relays the stories of several women, exposed to the violence of war, and to sexual abuse, who break down, unable to leave the trauma behind.
Unfortunately, the experience of these women is not rare:
No matter how you look at it, Iraq is a chaotic war in which an unprecedented number of women have been exposed to high levels of stress. So far, more than 160,000 female soldiers have been deployed to Iraq and Afghanistan, as compared with the 7,500 who served in Vietnam and the 41,000 who were dispatched to the gulf war in the early ’90s. Today one of every 10 U.S. soldiers in Iraq is female.
Despite the fact that women are generally limited to combat-support roles in the war, they are arguably witnessing a historic amount of violence. With its baffling sand swirl of roadside bombs and blind ambushes, its civilians who look like insurgents and insurgents who look like civilians, the Iraq war has virtually eliminated the distinction between combat units and support units in the military. ”Frankly one of the most dangerous things you can do in Iraq is drive a truck, and that’s considered a combat-support role,” says Matthew Friedman, executive director of the National Center for PTSD, a research-and-education program financed by the Department of Veterans Affairs. ”You’ve got women that are in harm’s way right up there with the men.”
There have been few large-scale studies done on the particular psychiatric effects of combat on female soldiers in the United States, mostly because the sample size has heretofore been small. More than one-quarter of female veterans of Vietnam developed PTSD at some point in their lives, according to the National Vietnam Veterans Readjustment Survey conducted in the mid-’80s, which included 432 women, most of whom were nurses. (The PTSD rate for women was 4 percent below that of the men.) Two years after deployment to the gulf war, where combat exposure was relatively low, Army data showed that 16 percent of a sample of female soldiers studied met diagnostic criteria for PTSD, as opposed to 8 percent of their male counterparts. The data reflect a larger finding, supported by other research, that women are more likely to be given diagnoses of PTSD, in some cases at twice the rate of men.
One factor explaining the high rates of female PTSD is sexual abuse:
A 2003 report financed by the Department of Defense revealed that nearly one-third of a nationwide sample of female veterans seeking health care through the V.A. said they experienced rape or attempted rape during their service. Of that group, 37 percent said they were raped multiple times, and 14 percent reported they were gang-raped. Perhaps even more tellingly, a small study financed by the V.A. following the gulf war suggests that rates of both sexual harassment and assault rise during wartime. The researchers who carried out this study also looked at the prevalence of PTSD symptoms – including flashbacks, nightmares, emotional numbing and round-the-clock anxiety – and found that women who endured sexual assault were more likely to develop PTSD than those who were exposed to combat.
Patricia Resick, director of the Women’s Health Sciences Division of the National Center for PTSD at the Boston V.A. facility, says she worries that the conflict in Iraq is leaving large numbers of women potentially vulnerable to this ”double whammy” of military sexual trauma and combat exposure. ”Many of these women,” she says, ”will have both.” She notes that though both men and women who join the military have been shown to have higher rates of sexual and physical abuse in their backgrounds than the general population, women entering the military tend to have more traumas accumulated than men. One way to conceptualize this is to imagine that each one of us has a psychic reservoir for holding life’s traumas, but by some indeterminate combination of genetics and socioeconomic factors, some of us appear to have bigger reservoirs than others, making us more resilient. Women entering the military with abuse in their backgrounds, Resick says, ”may be more likely to have that reservoir half full.”
Read these women’s stories here.
While these women, upon their return home, find that they cannot leave the horrors of war behind, Iraqi civilians are forced to live with those horrors day after day, year after year. Safety is gone. The trauma is not a discrete episode, or even a discrete period, but is life in the hell of postwar Iraq. Little attention has been focussed upon the impact on Iraqis of living with this hell on a daily basis. The San Francisco Chronicle has partially remedied this gap in a new article, here reproduced in full:
Civilian toll: Iraqis exhibit more mental health problems
James Palmer, Chronicle Foreign Service
Iraqi psychiatrists are seeing what they call a disturbing spike in mental health disorders as the war passes its fourth anniversary — a problem compounded by Iraq’s lack of mental health workers, facilities and services.
Several mental health care professionals suggest the number of untreated or under-treated people nationwide reaches into the millions, and the consequences could permanently harm generations.
“Iraqis are being traumatized every day,” said Dr. Said al-Hashimi, 54, a psychiatrist who runs a private clinic and teaches at Mustansiriya Medical School in Baghdad. “No one knows what will result from living through this continuous trauma on a daily basis.”
The government-run Ibn Rushd psychiatric center in the Iraqi capital provides examples of damaged people looking for help.
In a sparsely furnished office inside the hospital, Iraqis file in to describe their ailments to Dr. Haider Adel Ali, a somber 40-year-old psychiatrist.
Fanzia Jaafer, a 65-year-old housewife, has suffered from severe depression and suicidal thoughts since viewing the corpse of her son, whose head was nearly torn off by gunfire late in 2003.
Sundes al-Dulaimi, 27, said she has endured chronic headaches, insomnia, loss of appetite and panic attacks after the slaying of her 55-year-old father by a Shiite militia in June.
Zaman al-Keelany, 15, has experienced flashbacks of a rocket destroying a building in her neighborhood. The high school freshman said she has managed to continue her studies, but breaks down whenever she hears a loud noise.
Though no reliable research exists on the state of Iraqis’ mental health, the preliminary results of a survey of 10,000 primary school students in the Shaab section of north Baghdad, conducted by the Iraqi Society of Psychiatrists and the World Health Organization, reveals widespread problems.
The study, not yet published, found at least 70 percent of students were suffering from trauma-related symptoms, according to Mohammed al-Aboudi, Iraq’s national mental health adviser. Aboudi said those numbers appeared so high that the survey was redone — only to come up with similar results.
Ten-year-old Ahmed al-Dulaimi (no relation to Sundes al-Dulaimi) is one of the young Iraqis struggling to function.
Computer-savvy Ahmed, who enjoys playing soccer, stopped talking and refused to eat or drink when his family moved last year from their west Baghdad home to Fallujah for three months. They had moved after receiving a threatening letter with a bullet enclosed.
They have returned home and say Ahmed’s condition is improving. But the boy is continuing psychiatric treatment at Ibn Rushd as an outpatient, and Ali has prescribed antidepressants while advising the boy’s family to prevent him from watching violence on television.
“We’re now finding an elevation of mental health disorders in children — emotional, conduct, peer, attention deficit,” Hashimi said. “A number are even resulting in suicide.”
For some Iraqi doctors, the increase in the number of children traumatized by violence is apparent at the workplace and at home.
“I look into the eyes of children whose parents have been killed or are imprisoned every day,” said Dr. Nadal al-Shamri, a pediatrician at the Medical City health complex in Baghdad. “The psychological trauma is so deeply ingrained in some children that they may never lead a normal life.”
Al-Shamri said his 7-year-old son suffered an apparent nervous breakdown last year and stopped eating after the slaying of a close friend’s father.
“It’s difficult for me to eat after watching him cry,” al-Shamri said.
During Saddam Hussein’s 24-year reign, mental health was a forbidden topic, psychiatrists said. But today, things don’t seem much better.
Iraqi psychiatrists, like most medical professionals here, are suffering from training and funding shortages. No psychotherapy or crisis centers exist, and Ibn Rushd is the only psychiatric hospital in the capital of 6 million people.
Patients at Ibn Rushd receive free treatment and medication, but those who can afford care at a private clinic pay roughly 5,000 Iraqi dinars — nearly $4 — for visits that usually last 30 minutes to an hour.
A shortage of prescription medication has resulted in a Health Ministry order limiting treatments to 10 days.
There is a similar shortage of psychiatrists, who have been among the professionals and intellectuals leaving Iraq in response to a campaign of intimidation.
Mental health adviser al-Aboudi, who also heads the Iraqi Society of Psychiatrists, estimates at least 140 of the country’s 200 psychiatrists have been killed or have fled during the past four years.
Ali, who earns $300 monthly, is determined to remain, and he has the scars to prove his courage: two bullet wounds in his right arm from an assassination attempt in his clinic last year.
Remarking on Iraq’s diminishing psychiatric resources, Ali said, “There is little interest from the government. We ask for training and assistance with (creating psychiatric) centers, but get nothing.”
While consulting a string of patients one morning last month, Ali offered advice, prescriptions and, perhaps most important, compassion.
Jaafer, the housewife with suicidal thoughts, was cloaked in a traditional black abaya and clutched a white tissue in her right hand as she sat on a chair adjacent to Ali’s desk and described the difficulties of coping with the killing of her 29-year-old son, Haider, more than three years ago. “Whenever I remember seeing his body at the morgue, I start to cry,” said Jaafer, who complained of insomnia and losses of memory and appetite.
To make matters worse, Jaafer said, her family provides no support or sympathy. “They don’t believe I’m really suffering,” she said. “They just tell me to stop crying.”
Ali looked down at his desk and paused for a moment to let Jaafer wipe the tears.
“We have all lost a dear one — you should try to speak to other women who have lost their children,” he said, before writing her a prescription for Valium.
That’s about the best someone like Jaafer can hope for during a visit to the hospital. Anyone who wants or needs other psychiatric treatment “must go abroad,” Ali said.
With no end to Iraq’s troubles on the horizon, mental health professionals say the entire population eventually will require some type of healing. Hadoon Waleed, a psychology professor at Baghdad University, painted a grim picture when questioned about the future.
“Within five years of the falling of the regime, all Iraqis will be traumatized,” he said. “We will all need treatment.”
1 comment March 19th, 2007