JANE EISNER Coping with war, body and soul

War has always driven people crazy. From the time Homer portrayed Achilles violently grieving over the loss of his friend Patroclus in battle -- weeping, fasting, mutilating himself -- the psychiatric cost of war has been well-documented. Achilles' wish for his own death marked a suicidal depression long before the term came into vogue.
How easily we forget.
Today, when long-range, computer-driven weapons are a starring feature of modern warfare, we forget that ordinary humans still are doing the killing. When war is fought far from home, in Iraq and Afghanistan, we can ignore the stomach-turning sight of children blown to bits in the cross-fire. We can turn the channel, instead.
That option is not available to the soldier in the field.
A study published last week in the New England Journal of Medicine reminds us that our fighting men and women suffer injury to the mind as profound as injury to the body.
Those costs, too, must be calculated when we assess the worthiness of war.
Major depression
Surveying three units from the Army and one from the Marines that had served in Iraq and Afghanistan, the study found significantly high numbers with major depression, alcohol abuse, and post-traumatic stress disorder. Worse, it documented a reluctance to seek the mental health services provided by the Veterans Administration.
Of respondents who met the criteria for a mental disorder, 65 percent said they didn't go for help because "I would be seen as weak."
"This finding has immediate public health implications," wrote the authors, who work at the Walter Reed Army Institute of Research. I'll say. The understandable fear of being stigmatized must be overcome by outreach, education and an aggressive message from the top that acknowledging such "weakness" is only human.
There's more. The study proved what common sense suggests: The more combat, the higher the risk of mental illness. The rates were lower in Afghanistan because there the situation isn't as violent, the firefights not as frequent.
But in Iraq, where more than 90 percent of respondents said they had been shot at and a high percentage said they had handled dead bodies, or seen a buddy maimed or killed, or killed an enemy combatant, the rates of mental disorder were far higher.
Truth is, although modern warfare may appear to be divorced from the messiness of bloody interactions, the psychiatric costs of war continue to be profound.
"Indeed, for the combatants in every major war fought in this century, there has been a greater probability of becoming a psychiatric casualty than of being killed by enemy fire," Dave Grossman and Bruce K. Siddle wrote in the Encyclopedia of Violence, Peace and Conflict in 1999.
The civilian population of England withstood horrendous bombings and deprivations during World War II, yet a 1949 study found very little psychiatric fallout. Medical personnel and chaplains are on the front lines but don't experience more than the usual mental suffering.
The difference: They didn't have to kill other human beings. Humans are, by nature, reluctant to do so except in extreme cases of self-defense. Even in times of war, studies show that when left to their own devices, men have been unwilling or unable to kill.
Harm's way
Modern military training therefore has focused on conditioning soldiers to overcome that resistance. But in preparing recruits to kill, this training has unwittingly placed them in a different kind of harm's way: The harm of living with the consequences. Of soldiers who saw combat in World War II, only 20 percent fired their weapons at an exposed enemy soldier, write Siddle and Grossman. In Korea, it was 55 percent. By Vietnam, training had gotten so good, the percentage was 95.
In his book "Achilles in Vietnam," Jonathan Shay recommends that soldiers be allowed to grieve the way Achilles grieved: publicly, communally, as a way to provide "secondary prevention of combat trauma." But, Shay adds, "It cannot be too strongly stated that "primary prevention of combat trauma is the elimination of the social institution of war." No doubt Achilles would agree.
X Jane R. Eisner is a columnist for the Philadelphia Inquirer. Distributed by Knight Ridder/Tribune Information Services.