The Army is struggling to hire more mental-health professionals to treat soldiers for readjustment problems.
It is burying a record number of troops who died by their own hands. Alcohol abuse and drug use discharges are up, and chaplains are holding marriage retreats to help families deal with a worrying number of divorces and domestic violence cases.
These are a few of the unwelcome consequences of the nation's wars in Iraq and Afghanistan, which have whipsawed soldiers and their families from one long, combat deployment to the next for most of the last decade.
"We've never done a war this way before," said Brig. Gen. Rhonda Cornum, a flight surgeon and former commander of the Landstuhl Regional Medical Center in Germany.
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The Army, frustrated at its inability to get ahead of problems, has adopted a new tack -- resiliency training for every single man and woman who wears green.
Army leaders, led by Secretary of the Army John McHugh and the service's top generals, are convinced that they can prevent some of the negative fallout on the home front by making soldiers more "psychologically fit" before they deploy.
"Listen, you don't just decide to climb Mount Kilimanjaro one day," said Cornum, who is leading the effort. "You get ready for a year before you do something like that. In the same way, we need to mentally and physically prepare for these deployments. If you go into it psychologically fragile, you're not going to come out better."
Soldiers, particularly the young, are often ill-equipped to handle prolonged stress and become vulnerable to worst-case thinking, Army officials say. The emotional and psychological training is designed to help them "bounce back" through more positive thinking, a type of training one can imagine being received skeptically at the tank range or in the Ranger Training Brigade.
At Fort Hood, which has sustained more than 545 soldiers killed in action, more than any other Army installation, senior officers needed no encouragement on implementing the concepts.
Beginning in late 2008, then-Fort Hood commander Lt. Gen. Rick Lynch started building a "resiliency campus," where soldiers and family members could participate in outdoor adventures, get financial counseling, talk to a marriage therapist and work out, all in the same general location.
While Cornum's program "was trying to get legs under it, Gen. Lynch didn't wait," said Col. William Rabena, the campus commandant. "He was hot off a rotation to Iraq as a division commander, and he saw the toll it took on his soldiers and families. He didn't want to wait, so he moved out on his own. A lot of the goals are the same -- improving the mind, body and spirit."
Mental toughness, with help
Alexa Smith-Osborne, a social-work professor at the University of Texas at Arlington who conducts research on resiliency among troops and veterans, credits the Army for attempting to give soldiers the tools to rebound psychologically from difficulties, even if the science behind the psychology is still emerging.
"One always has to be careful about being too optimistic, but there is science to support preventive efforts to build stress moderators, stress buffers and coping skills in people," said Smith-Osborne, the daughter of a career soldier and combat veteran. "All of those have been found to have some effectiveness."
But she has a few cautionary words for the Army too because even the strongest people can break down under enough stress.
"The Army needs to spend just as much energy on solving the problems of not having enough combat troops, of overcommitting them, of repeated cycles of deployment," she said. "They also need to make sure they don't appear to be blaming the victim for not being 'hardy enough,' particularly within a culture that prizes stoicism and toughness and courage."
Cornum isn't just a theorist on the subject of mental toughness.
A physician and flight surgeon in a helicopter unit during the Persian Gulf War, she was shot down in February 1991 while on a search-and-rescue mission. Five soldiers died, and three were captured by the Iraqis, including Cornum.
She was physically abused and sexually fondled by her Iraqi captors and returned to the U.S. with numerous injuries. They are facts, but Cornum doesn't spend much time talking about them.
Instead, she says living through the experience made her a better wife and mother, made her a more sympathetic physician and a better commander.
"I would never suggest you get shot or burned just so you can grow," she said, "but I am convinced that the way to ensure success when you come out of a stressful experience is to be well-prepared when you go into it. I haven't just read about it. I've lived it."
Ending bad thoughts
Gen. George Casey, the Army's chief of staff, initiated the program in the summer of 2008 and tapped Cornum to lead it. By October, after months of working with researchers at the University of Pennsylvania, the Army rolled out the Comprehensive Soldier Fitness program.
Casey "wants to train everyone in the emotional realm to the same level that we train in the physical," said Col. Marsha Lilly, who is in charge of getting the message out to the troops.
But Casey has acknowledged that he is concerned that talk of emotions and coping strategies will seem too new-agey to an institution dominated by young men and combat veterans.
"I'm still not sure that our culture is ready to accept this," Casey told The New York Times last year. "That's what I worry about most."
The backbone of the program is a 15-minute online assessment designed to measure a soldier's "emotional fitness" by asking questions about relationships with family and friends, spiritual beliefs and social interactions.
The assessment kicks out a bar graph in several areas, with the "score" higher the farther it extends to the right. (The Army avoided numerical scores for fear of soldiers thinking they failed.) Then it offers feedback on areas where a soldier should get additional training for improvement.
Every soldier in the Army, including the Army National Guard and reserves, is required to take the assessment by June. More than half of them already have.
The tool is not used to screen for mental-health problems, and no one could look at the results and make a diagnosis, Cornum said. Nor are a soldier's individual results sent to commanders, she said, although the Army tracks the overall results.
Lastly, the Army is sending thousands of its noncommissioned officers to a two-week course to learn how to take the lessons back to their units. Those sergeants are then called "master resiliency trainers."
As a rule, the "emotional fitness" scores have predictably been highest among colonels and generals and lowest among privates and corporals.
Life experience matters a great deal in how soldiers handle stress, experts say, not to mention the backgrounds of soldiers. If a 19-year-old soldier grows up in a house where the parents didn't have good coping skills, they're not likely to have them either, Cornum said.
"It's not always that older troops have significantly more emotional strength, they have just developed ways to deal with it," Cornum said. "People who are older may well be struggling with the same issues; it's just their coping strategies are better."
Post-traumatic stress is the normal response to a horrific event in war, Cornum said. What's not normal is post-traumatic stress disorder, which means that nightmares, anxiety, hypervigilance, flashbacks and depression have overtaken a person's daily existence.
Rather than coping with drugs, alcohol, fighting, overeating or driving recklessly, Cornum wants soldiers to write in a journal, talk to a close friend, take up yoga or meditation and ramp up physical exercise.
"Grief is expected" after the loss of a friend, Cornum said. "But you have a mission. You have to go back to work. You will have other joy in your life. It's catastrophic thinking to say, 'Because I'm sad now, I'll never be happy again.' We teach people ways out of that thinking."
Trusting and hoping
At Fort Hood, about 2,500 people are going to the "resiliency campus" a week, and the number is growing, Rabena said. The post had many programs to help soldiers or families, but they were spread out and never achieved any coordination. As a result, many of them were underutilized, he said.
As an example, he said, every platoon that returns from a combat deployment is now required to go through "battle mind" training, in which they learn what adrenaline does to the body and constructive ways to achieve a "rush" at home. Then the unit goes kayaking, rock climbing or engages in a paint-ball battle as a team-building exercise.
"It was never mandatory before, but now every platoon has to do it within 120 days of redeploying," Rabena said. "That's an example of a program that was out there that is now getting used. It's getting rave reviews too."
Other than anecdotal evidence and the number of users, Rabena said he has no proof the center's programs are making a difference. He's still trying to develop quantitative measures of performance.
"Depression, anxiety, PTSD, substance abuse -- we're convinced it will have a residual effect on reducing those," he said. "That's not necessarily what we're trying to get at, but I think it will be an ancillary benefit of what we're doing. I think we've already made some progress on reducing the stigma that if you're looking for help, then you're weak."
Researchers at Penn have found that the methods can help children and teenagers with coping skills, and a similar program for at-risk Navy recruits showed encouraging results.
But Cornum and Lilly said the Army is, at this point, trusting and hoping.
"We can't substantiate it that this will lick the problem because we don't have the data," Lilly said. "But short of something better, it is a start."
CHRIS VAUGHN, 817-390-7547