Page 70 - Biobehavioral Resilence to Stress

The Stresses of Modern War 47

time spent in garrison (home base), and instability of garrison location (Bell,
Bartone, Bartone, Schumm & Gade, 1997).

Current conflicts in Iraq and Afghanistan have been unexpectedly stress-
ful for many members of the U.S. military. After a relatively brief period of

intense combat, the current war in Iraq has evolved into the most extended

conflict since the Vietnam War. The nature, scope, and duration of cur-
rent military operations in Iraq have forced American war fighters to con-

front and endure uniquely stressful conditions, confl icting demands, and,
sometimes, ambiguous expectations. Combat-related risks and exposure to
extreme stress and trauma are now experienced as actual or potential threats
to all service members, regardless of their occupational training or opera-

tional duties. There is no clearly defined “front line” in Iraq. Th e methods

employed by a determined insurgent militia—sudden, frequent, and inher-
ently unpredictable roadside attacks—are more similar in kind and eff ect to
those of terrorism than those of traditional warfare. For American and coali-
tion war fighters who have been trained to oppose more traditional enemies,

this context is uniquely stressful (Hoge et al., 2004; Holloway & Benedek,
1999; Maguen, Suvak & Litz, 2006).
In addition to the unique character of current military confl icts, war
fighters whose roles were once recognized as noncombative in nature are

now fully vulnerable to direct or observed violence. For example, service
members who are assigned to specialties such as administration, mainte-
nance, and logistics are now at an increased risk for negative health and

mental health outcomes because they are often exposed to dead bodies
(e.g., recently killed combatants or human remains from mass grave sites)
(Ursano, Fullerton, Kao & Bhartiya, 1995; Ursano & McCarroll, 1990).
Although conventional combat usually provides temporally distinct separa-
tion between expected periods of high-stress combat operations versus less
stressful periods of service at lower intensity or operational tempo, current

conflicts largely erase this distinction. Service members in Iraq are con-
stantly vulnerable to insurgent attacks such as roadside bombs and kidnap-
ping. Although their level of exposure and resulting stress may vary from
day-to-day, military personnel know that no matter where they are assigned
or engaged in Iraq, they are on the “front line” and may be targeted by

insurgents. Thus, the U.S. military personnel rarely have an opportunity to
fully “decompress” or recover from combat-related stress. Even those who

have not been deployed to the operational zone of conflict know that they
may be vulnerable. Incidents such as the bombing of Khobar Towers and the
attack on the USS Cole underscore the essentially permanent vulnerability
of modern American military personnel.
As noted recently by Maguen et al. (2006), few large-scale studies
have yet been conducted to assess the incident rates of stress-related or
psychological casualties from Iraq and Afghanistan. Using anonymous

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