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Extending Tours, Stressing Troops

Despite a growing body of medical research, the Pentagon is extending tours of duty to their longest levels since World War II, precipitating the first time in history that active-duty soldiers will spend more time in combat than at home

Sarah Olson

Exhausted members of Bravo Company, 1st Armored Division, 6th Infantry Regiment, relax after a long patrol in Mahmuydiyah, Irag. On the wall behind them are messages of support from children in the United States.

Justin Thompson, 23, proposed to Erin underneath the Eiffel Tower last February. The photos of the two on her MySpace page have the hallmarks of a young couple in love. Thompson can’t wait to get back to Lacey, Wash., to get married, and go to college. There’s one problem: Thompson is in Baghdad, serving his second deployment as a sergeant in the U.S. Army, and he is losing hope that he’ll ever be allowed to leave.

Sgt. Thompson, assigned to the 3rd Stryker Brigade Combat Team of the Second Infantry Division, was first deployed to Iraq in November 2003. When his unit returned to the United States one year later, he immediately started hearing rumors of redeployment and stop-loss – the military’s age-old policy that compels soldiers to continue serving during wartime, even after their contract expires. Four months later, the rumors were confirmed and Thompson was stop-lossed. Despite exhibiting signs of combat-related depression – uncontrolled anger and heavy drinking, for which he was repeatedly disciplined – Thompson redeployed to Iraq on June 28, 2006, exactly one day after his contract with the Army expired.

This April, while stationed in Baghdad, Thompson received another surprise. This second, involuntary tour would be extended by three months, as part of the Pentagon’s new policy that the Army’s standard tour of duty would be extended from 12 to 15 months. The news was devastating. 

I felt that I’d given everything I had to give,” Thompson says. I felt that I’d pushed myself to the brink of insanity and back and that still wasn’t enough. I fought in a war I didn’t agree with, but I’d taken an oath saying that I would serve, so I did. I felt used up.”

The Pentagon made this decision in spite of a growing body of medical research – all of which was available before the policy change – that shows longer tours are a primary cause of combat-related stress. Research also shows longer tours increase the psychological impact of traumatic experiences on soldiers, correlate to an increase in combat ethics violations, and put intense strains on military families. In short, increasing the length of deployment puts American soldiers, their families and Iraqis in danger.

Extending tours of duty

On April 10, 2007, when the Pentagon announced that it was extending the standard tour to 15 months for all Army soldiers, it created the longest tours of duty since World War II. It also precipitated the first time in history that active-duty soldiers will – as a matter of policy – spend more time in combat than at home.

According to Defense Secretary Robert Gates, the extensions were needed to implement President George W. Bush’s troop surge” and the associated Baghdad security plan. Gates called the extensions difficult but necessary,” acknowledging that the longer tours would place a heavier burden on already war-weary soldiers and their families, but also suggesting that the consistency of the policy might relieve the uncertainty of its previous policy. 

The decision is inexplicable to Dr. Charles Figley, director of the Psychological Stress Research Program at Florida State University and a pioneer in the field of traumatology. In 1975 he helped convene the Consortium of Veterans Studies, which coined the term post-traumatic stress disorder” (PTSD).

Usually, changes in policy are driven by evidence,” Figley says. But these changes are being implemented to satisfy a political, civilian goal. We’ve never in history had a situation like this, with a war this long and with this many multiple deployments.”

Psychological costs

To date, more than 1.5 million members of the armed services have cycled through Iraq. One-third of these have served two combat tours, 70,000 have served three, and 20,000 have been deployed five times or more. 

The majority of soldiers experience some sort of traumatic event during their deployment. According to a 2004 study by Dr. Charles Hoge and his colleagues at the Walter Reed Medical Center, 95 percent reported seeing dead bodies, 95 percent reported being shot at, 89 percent said they were ambushed, 86 percent said they knew someone who was killed or wounded, and 69 percent said they had seen injured Iraqi civilians, but felt they could do nothing about it.

A 2006 study by the Army’s Mental Health Advisory Team (MHAT) found that 17 percent of soldiers returning from Iraq screened positive for symptoms of combat stress, and that acute combat stress is substantially higher in soldiers with prior deployments; 18 percent of soldiers with prior deployments screened positive for acute stress compared to 12.5 percent on their first deployment. This study also found that at least 14 percent of soldiers currently serving in Iraq are taking drugs to treat depression or trauma.

The Army’s fourth MHAT study, released in May, is the first to examine deployment length. It found that deployment length is one of the top non-combat-related factors that contributes to stress. Soldiers deployed for longer than six months are roughly 150 percent more likely to experience acute stress than soldiers deployed for less than six months. These findings coincide with those of a 2006 RAND Corporation study, which found that as the length of the tour increases, so does the rate of stress reactions. 

The May MHAT study also examined for the first time combat-ethics regulations. It found that while 10 percent of soldiers admitted to mistreating Iraqi civilians, soliders experiencing combat-related stress were twice as likely to do so. The findings suggest the one bad apple” claims that the military promulgated during recent court-martials is nonsense. Not only are combat-ethics violations predictable, they are also direct results of decisions made by the Bush administration and the Department of Defense.

War is indeed hell

For many soldiers, acute stress is the natural result of their experiences on duty. As an infantryman, Thompson says he’s deeply troubled by what he’s seen during his tours of duty in Iraq. Consequently, he has become outspoken in his opposition to the Iraq War, despite still being on active duty. 

When you kick open an Iraqi’s door in the middle of the nightk, wake up a family, watch the children cry and listen to the women scream, the last word that goes through your head is hero,” he says. When you arrest the family’s father because he’s a suspected IED maker, who you know is most likely innocent, and hand him to the Iraqi Army who will beat a confession out of him, hero isn’t as accurate as state-sponsored terrorist. When the streets are flooded as far as you can see with protesters demanding that the United States end its operations in Iraq, you don’t exactly feel like you’re liberating anyone.”

Thompson says he understands what has allowed him to survive in combat. I recognized that in order to cope with what I had to do – in order to cope with killing – I had to make my heart cold. I had to dehumanize Iraqis in order to justify killing them. Even though I’d become aware of this behavior, I couldn’t let go of it. I had to become something I wasn’t in order to save my sanity.”

According to Carl Mumpower, a therapist who specializes in post-traumatic stress disorder and veterans issues, such reactions are normal. Turning off the switches that you’ve worked so hard to turn on in order to survive in a war zone is not easy.”

The process of transitioning out of a war zone takes a long time, especially for people who have experienced multiple traumatic events, Mumpower says. The problem is that with increasingly frequent and longer deployments, soldiers do not have enough time away from the war zone to recover and heal. And when redeployed, someone who has not fully recovered from their previous deployment is more likely to suffer serious combat stress injuries.

Figley likens soldiers’ combat stress injuries to runners’ sprained ankles. You can go on various long runs throughout your life,” he says. But if you run on a sprain, you are asking for a more serious injury. You don’t run on a sprain. You need to give yourself time to heal.”

Readjustment and delayed trauma

Soldiers serving for longer and multiple deployments have higher levels of combat-related trauma and consequently are at greater risk of experiencing any of the myriad post-deployment and readjustment problems when they return home. 

Studies indicate that soldiers can screen negative for combat stress injuries upon returning from Iraq, but screen positive seven months later. An October 2006 study, published in the American Journal of Psychiatry, found that 78 percent of veterans who had screened negative for symptoms of PTSD or depression one month after returning from Iraq screened positive when tested again six months later. 

These findings raise two concerns. First, if it takes time for symptoms of depression or PTSD to manifest, then prolonged follow-up care for soldiers is vital. Military officials claim mental health care is available to soldiers both at home and in Iraq. But significant barriers stand in the way of accessing that care and personal testimony indicates it’s not always available. In his 2004 study, Walter Reed’s Dr. Hoge found that only about 40 percent of soldiers screening positive for combat-related mental health disorders had expressed interest in receiving help from the military. Of that 40 percent, only 23 to 40 percent had received counseling within the past year.

The second concern is that soldiers are being redeployed to Iraq before they have been diagnosed with PTSD or depression. Consequently they are serving second, third or even fourth tours suffering from undiagnosed stress disorders. In 2006, the under secretary of Defense responsible for Health Affairs, in a deviation from previous policy, announced that service members with diagnosed mental health problems and those taking psychotropic medications could be redeployed. Yet all available research indicates soldiers experiencing acute stress are more likely to harm Iraqi civilians and sustain mental health disorders. 

No help on the horizon

Despite the studies clearly linking longer tours with higher rates of combat stress, Defense Secretary Gates is considering even further extending the tours of troops currently serving in Iraq – this time from 15 to 18 months. Gates says this is a worst-case scenario,” but few other options exist if troops levels are to be maintained at current levels.

While members of Congress are quick to verbally support the troops, their words are not always followed up by action. In July, Sen. Jim Webb (D‑Va.) introduced legislation specifying that active-duty soldiers receive at least the same length of time at home as their deployment in combat. Although this modest measure received 56 votes, that was still four shy of overcoming a Republican filibuster. On August 2, the House passed a similar measure, which included a provision allowing the president to disregard the new required rest time if deployment is necessary to meet a threat to the national security interests of the United States.” 

President Bush has threatened to veto the bill, and the House’s 229 to 194 vote margin lacks the two-thirds majority needed to override a presidential veto. Upon passage of the August 2 measure, the White House issued a statement saying the bill would impose inappropriate, operationally unsound and arbitrary constraints on how the Department of Defense should prepare units to deploy.”

But the failure to redress troops’ mental health concerns hasn’t been solely the fault of politicians. After finding that only 5 percent of soldiers in Iraq take any rest and relaxation, the Army’s May MHAT study recommended that troops in high intensity combat receive one month of in-theater R&R for every three months of combat. The report says it has long been recognized that mental health breakdowns occur after prolonged combat exposure,” and that the conditions under which today’s soldiers are fighting constitute an undue burden. A considerable number of soldiers and Marines are conducting combat operations every day of the week, 10 – 12 hours per day, for months on end.” Shortly after the MHAT study’s release, however, Pentagon officials quickly rejected its recommendations as unworkable.

Often, programs are not only underfunded or politically unfeasible, but encounter real, structural problems. For example, two recently introduced programs – the Army’s Combat Stress Control program and the Operational Stress Control and Readiness program for the Navy and Marines – provide front-line combat stress relief by embedding mental health professionals within military units. In addition, the Army announced plans in June to spend up to $33 million to add 200 more mental health professionals to its ranks. But both proposals have ignored the observations of the American Psychological Association that roughly 40 percent of the funded positions for military mental health providers are vacant and cannot be filled.

And so it goes …

As for Thompson, he’s still in Baghdad, trying to make sense of what he’s been asked to do. He doesn’t see the U.S. military presence achieving its goals, especially when it comes to the business of winning hearts and minds” that the Pentagon’s always talking about. For that, you need cultural exchange and interaction – something a military occupation makes impossible. So much is lost when you hold a gun,” Thompson says. You can’t just go to the bakery downtown and get some flat bread. You go to the bakery in a flak vest and helmet, with your M4 accompanied by vehicles and aerial support.”

Thompson says everyone he’s talked to feels the painful impact of the extensions. Imagine having every facet of your life dictated to you – when to wake up, what to wear, where you’re going. It’s never something you liked, but you do it because you made a commitment. Then you find out you have to stick around for another year. Soon, that year becomes 15 months. And even when the media does talk about the troops,’ no one ever discusses what soldiers live with every day. We are in a country where our friends are going to die, and we may or may not make it back to get married and go to college.”

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