Traumatised by the battlefield or the anguish of divorce caused by long absence from home, many American troops in Iraq are increasingly shedding their macho image and visiting Combat Stress Clinics.
Four years ago, following the 2003 invasion that ousted Saddam Hussein, the US military drew together psychiatrists, psychologists, social workers and specialist nurses in spacious buildings where troops could be treated.
AdvertisementFor a few hours or maybe days, shattered soldiers can talk over their problems, receive treatment or simply stay in the clinic for a while to rest.
The Baghdad area clinic is near the airport at Camp Liberty, one of the world's largest military bases and home to some 50,000 troops.
Clinic commander Kevin Gormley told AFP: "You certainly still have this macho culture in the military, it's important not to appear weak.
"But I tell you, the stigma attached to mental health and to seeking some help in this matter has been largely reduced."
The importance of early treatment is widely recognised. Studies by the army or independent bodies are emphatic, many veterans of the Iraq or Afghanistan wars show psychological difficulties upon their return home.
One study, by the Rand Corporation, found that some 300,000 out of 1.6 million soldiers rotating back to the United States since 2001 showed signs of psychological problems of varying degrees.
According to the Pentagon, between January 1 and the end of August this year, 21 troops committed suicide in Iraq and another 39 did so after their return home.
Military headquarters accepts that the sooner stress-related problems are tackled on the battlefield, the greater the success in treating them, said Gormley.
On arrival at the Combat Stress Clinic a soldier is seen by a psychiatrist who diagnoses problems, suggests treatment perhaps involving regular visits, or recommends a stay at the clinic as an in-patient.
"Obviously in war crazy things happen. It's hard to deal with all of that. So stress is a very normal reaction," said Lieutenant Edmund Clark, one of the psychiatrists.
"It's normal for people to be scared. A certain amount of anxiety is even healthy. Our job is to help them have normal reactions to abnormal stresses.
Clark added: "It's not only combat that brings soldiers to us, it's also home-front issues. As things calm down here in Iraq, things may pick up on the home front.
"It's the holiday season, it's very difficult to be away. You may end up having more people coming to see us because of home-front issues."
At the forefront of such issues is divorce, or splitting up for those who are not formally married, Clark said.
Classes at the clinic take place throughout the day on topics such as resiliency, anger management, depression and coping with grief, positive thinking, relationship maintenance, relaxation and sleep hygiene.
If the soldiers live on the base they may come in for the day, but if they are stationed farther away, they can overnight at the clinic which has 48 beds.
Officers who know of a soldier's problem can recommend a visit to the clinic but cannot force attendance. And if an officer knows of a trooper's visit and has to give an opinion, absolute confidentiality is guaranteed.
For years, any soldier needing psychological treatment would feel it was something shameful that would harm his or her progress in the military.
But Gormley said this is no longer the case, and the top brass is in fact increasing its initiatives to deal with such cases.
Clinic staff also go out into the field and visit troops at other bases, Gormley said: "We don't wait for them here, we can take our bags and be out there in the field, sleeping with them in tents."
When troops became used to seeing staffers from Combat Stress Clinics, it made it easier for the soldiers to visit the clinics in person if they felt they needed help.
But Gormley also acknowledged: "The first and often the best health care providers are what we call the 'Buddy system' - it's your friend, your comrade, the one who knows you and can see in a second that something's wrong.
"Often times, talking to your buddies in your platoon will be enough to lower the stress level."
It is message that is strongly driven home on a poster on a wall of the clinic waiting room.
"Never leave a buddy to fight alone," it says. "Be willing to listen. Not all wounds are visible. Prevent suicide. It's your responsibility to get help for a fellow soldier."
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