Edition: U.S. / Global

A NATION AT WAR: IN THE FIELD | V CORPS; Therapy on the Fly for Soldiers Who Face Anxiety in the Battlefield

Published: April 6, 2003

The other day, the buddy of a frightened soldier took him to see Maj. Graham Hoffman, a psychiatrist from Pueblo, Colo., and a reservist who has been called up to serve in the war against Iraq.

''He was frightened of going to Iraq and afraid of chemical attacks, couldn't get it out of his mind,'' Major Hoffman said. ''It seemed like a pretty normal amount of fear.''

Major Hoffman, who serves with the 883rd Combat Stress Control Detachment, a unit run by psychiatrists, said he tried to ''reframe'' the fears of the soldier in order to calm him. The doctor told the soldier that it was perfectly natural to be scared, and that, even though a chemical attack would be dreadful, it would probably not prove fatal to many soldiers because of their training and the masks and outfits they wear to protect against such an assault.

''We talked about ways to relax,'' said Major Hoffman, a quiet-spoken, 46-year-old doctor who joined the Army reserves after the Sept. 11 attacks. ''This was a guy who was really keyed up. We taught him simple things -- holding your breath, letting it out after five seconds, feeling the tension leave your body. Semi-hypnotic stuff. Self-massage. He seemed much more reassured when he left.''

There are two combat stress units in V Corps, the Army force in the Iraq war, teams of doctors who treat soldiers struggling with fears and anxieties. (In addition, each division has a psychiatrist, psychologist and social worker assigned to it.)

Many medical personnel in the Army are reservists. Civilian psychiatrists like Major Hoffman serve a minimum of three months in a theater of war, like Iraq, but may serve much longer at the government's request.

In contrast to their work in civilian life, psychiatrists in the Army are less engaged in resolving the personal problems of soldiers than getting them back into the field as quickly as possible.

Antidepressants and antianxiety medications, commonplace in civilian life, are not prescribed for soldiers, for example, at least in the early stages of their treatment.

''Our job is not to get into prescriptions because we don't see battle stress as an abnormal response situation,'' said Maj. Timothy Patterson, a psychiatrist and reservist from Mansfield, Ohio, who runs a combat stress unit.

''To start using medicines gives soldiers the impression that they're patients, and they're not,'' Major Patterson said. ''We see them as soldiers having a normal amount of stress in an abnormal situation.''

Combat stress symptoms include ''feelings of anxiety, upset stomachs, somatic complaints -- anxieties that are converted to body illness -- twitching, as well as emotional and maybe even spiritual problems.''

Major Patterson said that initially, several days of rest, fluids, hot food and sleep left most soldiers ready to return to their combat units. Often sleep deprivation -- and commanders' not realizing that soldiers need plenty of sleep -- leaves troops unable to function properly.

Major Patterson said that about 80 percent of soldiers treated by the combat stress unit returned to their units after several days of rest and relaxation.

Major Hoffman said that combat stress units in the Army go back to World War I, when recuperation areas were created to help anxious soldiers. In recent years, he said, the Army had studied the Israeli Defense Force's methods of dealing with combat stress. The Israeli military was more or less in a permanent state of war, he said, with a defense force comprised of reservists and others.

The Army had created several channels to deal with combat stress, Major Hoffman said.

If a soldier, he said, ''is not able to normalize the emotions they're experiencing, not able to maintain cognitive control,'' the Army often places them in a headquarters unit for 7 to 10 days. The soldiers are assigned low-pressure jobs like kitchen duty and given further rest.

Unlike Vietnam, the officers said, when troubled soldiers were often flown out of the country to hospitals or stateside units, the Army makes deliberate efforts to keep soldiers near their units.

''Keep them close to their tribe,'' Major Patterson said. ''It sometimes hurts the individual in the long term to send them away. They carry a sense of failure, take it home with them. It's a horrible scar to bear.''

The combat stress units here have started relatively late, in part because their Humvee vehicles and communication equipment were delayed. In the past, Army commanders have sometimes given lip service to psychiatrists, viewing soldiers who visit them as slackers.

But a certain urgency in V Corps has given psychiatrists some importance after the recent arrest of a soldier in the 101st Airborne Division who is accused of throwing a hand grenade into a tent, killing two officers and wounding 13.

Major Patterson, who is 48, and whose practice in Ohio includes steel mill and factory workers who have been laid off or are unemployed, said the soldiers he meets in the mess hall sometimes question the reason they are in the Iraq war.

''That's why its important for officers to remind them why they're here,'' Major Patterson said. ''We lose sight of our goals. Soldiers want assurance. They have to be kept focused on their mission.''

Sitting outdoors in the pulsing desert heat in midafternoon, Major Patterson and Major Hoffman said it was normal for soldiers facing combat to also face fear and stress.

''Out here, we lose all the normal structures as to who we are,'' Major Patterson said. ''You're in a foreign situation. Look around. You're in the biggest sandbox in the world. With no toys, except guns. People get frightened. They have no control over their daily life. And they have to be reminded of the token skills that allowed them to succeed so far.''

Photo: Maj. Timothy Patterson, left, and Maj. Graham Hoffman are psychiatrists who treat soldiers for fear and anxiety on the battlefield. (Specialist Christine L. Andreu/United States Army)