It is important that we understand how combat and operational stress were treated for returning veterans of conflicts before 2003—but we must not rehash these lessons or attempt to use them as solutions to the challenges that contemporary combat veterans face. The norm of their exposure has shifted, requiring an expanded, enhanced, and more deliberate prevention and treatment strategy.
The generation of active-duty personnel who entered service before the continuing conflict in Iraq began in a more or less peacetime naval service. For them, the norm was periods of intensive operations, usually of short to mid-term length, followed by less stressful tours back home where reintegration into life in the continental United States was a matter of fact. This cohort includes personnel who are still on active or reserve duty and now rank E-6/O-4 and above.
But the generation who entered after 2003 does not know that norm. They have their own, very different from that of their mentors and seniors. Most have already served at least one tour in a combat situation, and many have served two, three, and even more. These are long periods of very intense operations, followed by 6 to 9 months at home preparing for the next 9- to 12-month combat tour.
These young warriors do not have periods for decompressing. Often their only nonoperational tours are as recruiters, very demanding stateside duty. This cohort includes personnel on active duty who rank from E-5/O-3 and below. They constitute the largest proportion of our total active-duty and reserve force and also the youngest, most at-risk personnel. They do not have a "safe" frame of reference for what they can expect back home. They may have nothing to look forward to but the excitement of their next combat tour. Their normal is not normal.
Perhaps the most critical periods for them are their brief stays at home. Picture the following recipe for disaster: A young warrior returns home from Afghanistan to an immature, perhaps slightly dysfunctional marriage or other serious relationship. With unlimited access to alcohol, he or she now has a chance to spend tens of thousands of dollars earned in combat pay and bonuses—and is placed in a seemingly temporary, boring position in the military's supporting establishment.
With no frame of reference for what "normal" means, nothing on which to depend professionally or toward which to strive, it is not surprising that some have great difficulty making good choices. Worse yet, they may begin to look forward to that next adrenaline rush under fire.
Serving the needs of this cohort and its new norm requires a much more mature and deliberate strategy for prevention and treatment. Intervention strategies, including embedded mental-health programs, need to be developed for each stage of the stress continuum: green, yellow, orange, and red. These strategies must be customized to fit their target audience: Navy Explosive Ordnance Disposal unit, Marine infantry battalion, Navy frigate or destroyer, or Marine sniper team.
Furthermore, those who reach out to these specific audiences need to have been there themselves. Only someone who understands the stressors, wears the ribbons and patches, and is trained properly in how to encourage open and honest dialogue should be used to attempt breaking down the psychological walls of combat-hardened fraternities, and those of groups of spouses who deal with the mess that comes home. Psychologically damaged veterans will not trust or open up to anyone who is not a proven comrade-in-arms.
Programs such as the Marine Corps' Operational Stress Control and Readiness training for Leaders, Mentors, and Extenders (OSCAR Leader/Mentor/Extender), the newly conceived OSCAR-Family, and the Navy's embedded mental-health programs (for units of the Special Warfare and Navy Expeditionary Combat Command communities) are right on target. These should continue to be developed and expanded. Appropriately trained mentors should be available at every unit. Our nation owes these fine young warriors a finely tuned, customized, metric-driven, integrated, and prevention-oriented operational stress-control and mental-health program. Normal or not . . .
Captain Need works for Battelle Memorial Institute as a research leader in Force Health Protection. He retired from active duty in 2003, after serving numerous tours as an operational preventive-medicine officer.