Psychiatrists Get Insider's View of Combat Stress

Col. Thomas Malone, M.C., chief of forensic psychiatry at Walter Reed Army Medical Center, had an existential moment during his six-month assignment to the 28th Combat Support Hospital (CSH) in Baghdad last fall.

“Like most of the hospital staff, I saw frequent enemy rocket attacks in the distance and blocked them out. However, I couldn't ignore the sound of an incoming missile nearby that exploded only two blocks from me. The possibility of being killed in Iraq became more real, and I had nightmares for a few nights,” said Malone.

He continued, “I realized that I had suppressed my fears about my safety, which is a common coping mechanism that soldiers use. This experience gave me a new perspective on my patients' reactions.”

Malone and several other physicians and nurses from Walter Reed were deployed with the CSH or its subordinate field units in Iraq for up to a year ending in February. They spoke at the Lt. Col. Kenneth Artiss Symposium last month at Walter Reed (see story at right).

Despite frequent rocket attacks, extreme heat, and logistical problems, U.S. and allied soldiers, Iraqi enemy prisoners of war (EPWs), and certain Iraqi civilians received the same standard of medical care at the CSH in accordance with the Geneva Conventions, according to Maj. Matthew Brengman, M.C., a staff physician in the department of surgery at Walter Reed and a trauma surgeon assigned to the CSH in Iraq.

Brengman said, “Once the war started, I was concerned about my personal safety and whether my professional skills would measure up to the challenge of operating on combat-related injuries.”

He rose to the challenge, as did the other surgeons, who specialized in neurological, thoracic, and oral surgery. “This was the busiest combat support hospital since Vietnam,” said Malone.

This was the second time the 28th CSH had been deployed to Iraq in support of military operations. The first deployment was in 1990 to support Operation Desert Shield during Operation Desert Storm, according to the CSH's Web site. The CSH remained in Iraq for 30 days after the “termination of hostilities” to continue providing medical care to American soldiers and Iraqi prisoners of war. The second time the CSH stayed in Iraq for a year, most of it after major military operations ended. Many physicians complained to the CSH commander that a year was too long a deployment, and thus the Army is now making an effort to rotate physicians every six months, said CSH Commander Col. Beverly Pritchett, M.C., at the symposium.