War Stories: Is R&R Wrongheaded and Reckless?

The conflict in Iraq is providing experts like Charles Figley a chance to put the psychology of war itself on the couch. Take rest and relaxation, for example. "There is a lot of research that shows that R&R is bad policy," says Figley, the head of the traumatology unit at Florida State University. He says that there is mounting evidence that indicates that those two weeks of leave to go home sometimes make things harder on soldiers. There are also some alarming statistics that suggest troops are more likely to be killed just before or just after R&R, because their minds are elsewhere. That's why some military psychologists are urging the top brass to consider not sending the soldiers currently rotating into Iraq home for R&R.

Canceling traditional R&R would not go over well with rank-and-file soldiers, but it might make them safer physically and mentally. There are other options besides a trip home. The British, for example, give their soldiers a break--but as a unit. This cohesion seems to make transitioning briefly into civilian life a lot easier. Doctors at Landstuhl Air Force Base in Germany, where most of the war wounded wind up, also believe unit cohesion is therapeutic. "They found that patients respond more quickly to medical treatment when they are in open bays rather than private bays," says Figley, who spent time at Landstuhl recently. The ability to talk with and even compare experiences with fellow soldiers seems to help recovery.

In his 1978 book, "Stress Disorders Among Vietnam Veterans," the professor found something similar. "We were expecting to find that the [Iraq] wounded would have higher rates of PTSD [post-traumatic stress disorder]," says Figley, himself a Vietnam vet. "We found the opposite. In contrast to most Vietnam vets--who came home so fast they still had the dirt of Vietnam under their fingernails--they had lots of time to process their experience." That may help explain why one widely respected study reported that one third of all Vietnam veterans suffered from PTSD at some point in their lifetime.

The rates from the war in Iraq won't be as high, leading experts say. One preliminary report from the Veterans Administration suggests that about 14 percent of returning soldiers suffer from psychological troubles. But that is only for those who are in VA hospitals. Figley worries that the actual number may be higher for those who aren't getting treated and therefore don't have that decompression period. "To me that is an indication that there are far more," he says. He worries most about reservists and National Guardsmen, who often deploy separately from their units and come home with little transition to their civilian lives, rather than a base.

The military does a much better job of helping soldiers reintegrate into society these days as opposed to any war in the past. Before coming home, soldiers in Iraq must spend a week or so in Kuwait. While there, they fill out a "risk assessment survey," which tries to gauge their mental health. But soldiers know that if they check too many boxes their return date might get pushed back. As one soldier explained it, the 10-minute survey process was a "check the box" exercise that most thought was a "joke." Once home, soldiers also have a mandatory counseling session, usually with a chaplain, to help them get on with their lives. This may still not be enough or the right approach. "If you talk candidly to every psychologist and psychiatrist in the Army, they would admit that it is too little too late too often," says Figley.

It used to be that when a soldier suffered from battle stress in the field, he got "three hots and a cot" then went right back to war. From the older generation of war veterans' perspective, today's soldiers are coddled. As far back as the 19th century, there was something known as PIE--primacy, immediacy, expectancy. That suggested that soldiers recovered from combat stress because they were expected to get back to the front line as quickly as possible. Many who study the military today say that when it comes to dealing with psychological trauma, the old way might just work best. "Sending soldiers back to their unit can be better than sending them to a psych ward," Figley explains. The psychology of war will no doubt be a patient for years to come.