Rules of Engagement

Rules of Engagement

A Civilian Therapist’s Guide to the Military Mindset

By Alison Lighthall

November/December 2010

Many coalition troops in Afghanistan and Iraq have spent five years alternating between trying to kill and trying not to be killed. Think back to what you were doing five years ago, and what you've done since then. Now imagine spending every one of those 2,629,800 minutes wondering whether it was going to be your last.

For more than 5,500 American combat personnel, it was. The 33,000 Americans wounded in action probably thought it was. The rest of the 1.9 million who've been deployed have wondered when it would be.

Comprehending the enormity of this life experience is a challenge. A recent study in the American Journal of Psychiatry reports that 58 percent of the men and women in active duty were exposed to dead bodies or body parts; 72 percent were assaulted or ambushed; 73 percent witnessed or experienced an accident causing serious injury or death; 79 percent know someone personally who was seriously wounded or killed; 81 percent came under fire. A study in the New England Journal of Medicine, conducted by Charles Hoge and colleagues in the early years of Operation Iraqi Freedom, found that 86 percent of soldiers and 92 percent of marines had been subjected to shelling and mortar fire. Being exposed to a traumatic event that involves death or serious injury--and therefore meets the criteria for PTSD in the Diagnostic and Statistical Manual (DSM IV-TR)--is part of the everyday environment for these young men and…

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