May 31, 2014: The U.S. Army has spent the last decade seeking more ways to deal with PTSD (Post Traumatic Stress Disorder). In addition to finding better techniques for quickly detecting and treating PTSD, the army has also sought ways to delay the onset of PTSD. One of the latest tools is TeCD 4A, a computer program that allows users to measure what impact more (or less) fuel, water, equipment and construction materials in small (under a thousand troops) bases in remote areas would have on morale. The core of TeCD 4A is data collected from asking lots of troops who have been in combat what different aspects of life in their combat zone bases did for their morale (mental wellbeing). While the army has minimal standards for food, water, housing and amenities on bases, no matter how remote or small, it is known that better quality of life out there does wonders for morale and reduces problems with PTSD. TeCD 4A can calculate what, given available resources, items should be sent to do the most for morale in a particular base. Astute officers and NCOs can figure this out in their heads using their own experience, but TeCD 4A gives even experienced commanders some sound baseline estimates which they can then tweak, or not (if they largely agree with the TeCD 4A recommendations). The usefulness of TeCD 4A is monitored and adjusted via continuing troop surveys.

The major problem here is that most troops in combat zones eventually get PTSD if they are in combat long enough. This has been confirmed by nearly a century of energetic efforts to diagnose and treat PTSD (including much recent attention to civilian victims, traumatized by accidents or criminal assault). During World War II, it was found that, on average, 200 days of combat would bring on a case of PTSD. After World War II, methods were found to delay the onset of PTSD. This included more breaks from combat, better living conditions in the combat zone, prompt treatment when PTSD was detected and so on. Military historians note that successful, and often popular, commanders throughout history have paid attention to the physical well-being of the troops, all in the name of "maintaining morale" and delaying the onset of mental (or combat) fatigue.

This explains why combat troops in Iraq and Afghanistan often sleep in air conditioned quarters, have Internet access, lots of amenities (like frequent access to showers), and a two week vacation (anywhere) in the middle of their combat tour. It was also discovered, quite by accident, that the troop habit of playing violent video games, in between bouts of real combat, reduced combat stress. Mental health practitioners tested the use of violent video games for their PTSD patients, and found out that it worked.

The PTSD problem is felt most frequently among combat NCOs. Most of the troops are in for one enlistment (usually four years) and then leave, usually without a severe case of PTSD. Similarly, junior officers get promoted out of jobs involving close combat, and officers in general are rotated between leadership and staff jobs. But NCOs spend all their time with the troops, except those few who get promoted to Sergeant Major (a largely staff job, as advisor to senior commanders.) The Sergeants Major were among the first to note the stress problems with career NCOs (squad and platoon leaders, as well as company 1st Sergeants) and have backed efforts to do something about it.

For a long time the only acceptable solution for NCO PTSD was to transfer the worst hit combat NCOs to non-combat jobs. This is a common sort of thing in the army and marines, where it's long been common for NCOs with physical conditions and injuries (resulting from the rigors of peace or wartime infantry service) to be offered transfers and retraining in less physically demanding jobs. Severe cases may also be offered a medical discharge (and disability pay for life). The loss of these skilled and experienced NCOs from combat units results in more troops getting killed or wounded in combat. That can happen anyway if you leave a stressed out NCO in action for too long. As a result the desire to cure PTSD, or at least greatly reduce its impact, has led to the search for drugs or therapies that actually work. Israeli researchers are working on drugs that appear to work, and therapies like video games and Mind Fitness do the job as well.

The army and marines are dealing with PTSD head on, believing that what happened in Iraq and Afghanistan, will happen again, and now is the time to get ready. Experience so far has shown that PTSD can be delayed, perhaps for a long time. When a soldier does come down with it, PTSD can often be treated, and its effects reversed. But not always. This has large ramifications for non-military medicine, for many civilians suffer from PTSD. That's because military recruits are screened for their ability to handle stress and resist PTSD. In the civilian community, there are far more people who can acquire PTSD after exposure to much less stress. What many troops wish the brass would understand is that, as recruits, they learned that stress was a major part of the job, and understood it more than the mental health mafia is willing to admit.