SOUTHERN IRAQ—It's the state of mind of the soldiers after the war that worries Navy Capt. Robert L. Koffman most.
Memories from the battlefields of Iraq, he fears, will prove especially devastating for the troops.
"War is insane to begin with," said Koffman, 50, the senior combat stress consultant for the Marine Expeditionary Force. "But here POWs are executed, the enemy changes uniform, children are used as shields."
From the field, the psychiatrist and doctor of aerospace medicine has helped keep a cautious eye on the psyches of individual Marines and sailors.
Along the way, he met a serviceman who "shut down" after he shot a female civilian he said charged at him with a machine gun during an ambush. The serviceman told Koffman that after he shot her, an inconsolable child ran over to the body.
The soldier was distraught to the point he could not function, Koffman said. "He had a normal reaction to an incredibly abhorrent situation."
It was during the first Gulf War, at a prison for Iraqi soldiers, where Koffman saw the worst reactions to combat stress.
"There were so many hapless conscripts, the guys who just went for a pack of cigarettes and then they were soldiers," he said. "I saw guys suffering from hysterical blindness, catatonia, pseudo-seizures."
At the same time, the doctor also witnessed some unhealthy reactions on the American side.
"Lots of men were taking home (Iraqi) AK-47s as souvenirs," he recalled.
That state of mind can be dangerous, said Koffman, who said there is more awareness today that soldiers may need help adjusting to the life back home.
"The military is very aware that you can't just switch off killers," he said.
Marine Sgt. Major Jeff Study, 44, of Marine Aircraft Group 16, said that during combat there is no time to reflect on the person behind the barrel.
"It's complete chaos. You figure if they are shooting at you, they are trying to shoot you," he said. "If you are reluctant firing a weapon, you could end up dead."
Study said he has seen the painful imprint of combat on men back home.
Some friends he served with in Desert Storm began drinking heavily, or re-lapsed after having been sober for years, Study said. But men he knows who served in Vietnam seem to have it the worst.
"We are sitting in a bar, and any loud bang, even if a car just backfires, scares them. They'll jump to the ground and stay low."
Navy Lt. Cmdr. Alan Jacovich, 35, a psychiatrist deployed from the Naval Medical Center in San Diego, said Marines and Army troops are most at risk for post-traumatic stress disorder.
"They have the highest amount of battle fatigue," he said. "Nutrition is so-so, you are dehydrated and not getting enough sleep. Then you see your buddy dead and are fearful for your own life."
Seeing civilian casualties will "plant self-doubt," Jacovich said. "Often you really have no choice. It's a surreal issue."
Some will fare better than others. Having experienced trauma earlier in life leaves some soldiers pre-disposed to depressive disorders from combat, he said.
The memories remain.
Marine Sgt. Michael A. Simmons, 23, saw civilians caught in the crossfire in Nasiriyah.
Simmons, a member of the Second Light Armored Reconnaissance Battalion, was part of a unit that shot up a convoy of buses carrying civilians, and Iraqi soldiers firing machine guns.
After the battle, he saw the aftermath up close: Several apparent civilians dead, all wearing robes.
"It pretty much broke me down," Simmons said.
Navy Chief Petty Officer Greg Tedrick, 35, a "Devil Doc," too, has had to cope with death up-close.
Tedrick helped extract the charred remains of Marines who died in a UH-1 helicopter crash during take-off in Southern Iraq.
He and a fellow petty officer worked from 8 p.m. until 2 a.m.
"I got every piece of every body out so the boys could be buried at home where they belong," he said, looking up toward the night sky.
Tedrick said he volunteered for the task to save the younger men and women in his unit from the memory. He said he is glad "his kids" didn't see what he saw.
"I can't get the sight or smell out of my head," Tedrick said.
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Marine Capt. Eric Garcia, 32, said it was the news of a neighbor back home dying in Iraq that hurt him the most.
Garcia, a CH46 pilot deployed from New River, N.C., who has been stationed in Southern Iraq, found out via an e-mail from his wife that his neighbor Fred died in combat after his unit tried to help a group of Iraqi fighters who had pretended to surrender.
"I was shocked," he said.
This, despite the fact he had co-piloted over a fierce battle in Nasiriyah the night before to pick up causalities.
"That didn't seem real—now it was personal. It made me feel much more vulnerable."
He wondered if his friend had been one of the KIAs (killed in action) he helped transport back.
Garcia said he felt "really depressed" and didn't fly for two days.
"Then I told myself to just get past it."
(c) 2003, Knight Ridder/Tribune Information Services.
GRAPHIC (from KRT Graphics, 202-383-6064): Soldier sleep