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November/ December 2013 Women, War, and PTSD

Are female warriors more likely to be traumatized by combat?

By Laura Kasinof

Former U.S. Army medic Jennifer Pacanowski’s speech was punctuated by loud laughter, even when the topic of conversation turned quite dark. “I’m looking for bombs,” she said, driving south on the New Jersey Turnpike, “so if anyone tries to blow up this roadway, I’ll be ready for it.” She laughed again, acknowledging the ridiculousness of her statement but unable to let go of the tricks her mind was playing.

Pacanowski, who’s thirty-three now, served in 2004 as an ambulance driver in Iraq, where she accompanied military convoys from the Al Asad Air Base in western Anbar Province, one of the most violent regions in a violent war. Despite serving in a “noncombat” role, Pacanowski often found herself in the line of enemy fire, witnessing firsthand the carnage of fatal roadside bombs or being forced to take cover during sniper attacks.

When she left the Army two years later, Pacanowski struggled to reintegrate back home and instead retreated to a log cabin in the Poconos, where she spent years “drinking too much,” she said, and rarely went outside. All she “wanted was to feel numb,” she told me. “How could I come home and not feel safe? At war, I wasn’t frightened by the mortars. Then I came back to America and couldn’t leave my house. It didn’t make sense to me at the time. I preferred to be angry and live in denial.” In 2007, Pacanowski was diagnosed with post-traumatic stress disorder, or PTSD.

While Pacanowski has since regained her footing—thanks, she says, to her supportive family, as well as to her work training bullmastiffs and volunteering with nonprofits serving veterans’ needs—both her difficulty returning home from war and her diagnosis are far from uncommon. The women who served in Iraq and Afghanistan (they now make up about 15 percent of the armed services) all technically held noncombat roles, but many, like Pacanowski, served on the front lines. Since the start of the war in Afghanistan in 2001, 149 women have been killed in the line of duty, and many more, like Pacanowski, have been diagnosed with PTSD or other psychological disorders as a result of their service.

The U.S. Department of Defense (DOD) announced its decision to lift the ban on women serving in combat roles in January of this year, opening up potentially thousands of new positions to female soldiers within the infantry, artillery, and Special Forces. This major policy change was widely praised by Republicans and Democrats, conservatives and liberals alike. Military leaders testified to the vital role that women have played in Iraq and Afghanistan while civil rights advocates argued that, without the badge of having officially served in combat, women have long been denied the recognition and career mobility they rightly earned for their wartime service.

But there’s another, less celebratory side of the story, too. In the past year, the media has uncovered the actual day-to-day experience of many women in the armed forces. It’s now headline news that female soldiers are routinely harassed, assaulted, and raped by their fellow soldiers or, worse, commanding officers; others have been deployed as young mothers with small children or infants at home, and others have returned from war pregnant. Still others, like Pacanowski, have simply struggled to negotiate the psychological whiplash between war and peace—between the expectations of a soldier abroad and those of a daughter, girlfriend, wife, mother, or office employee at home.

While it’s clear that war is hell for everyone, men and women alike, it’s unclear how the unique female experience in the barracks, on the battlefield, and back at home may affect them differently. Female veterans are already more likely than male veterans to be homeless, divorced, or raising children as single parents. Female vets under fifty are more than twice as likely as their male counterparts to kill themselves. And a growing body of research suggests that female vets may also be more susceptible than men to psychological disorders, including PTSD.

Those facts and new research—indeed, the very discussion of gender differences in the armed forces—are often incendiary, but they should not be taken as an argument against equality in the armed forces. Instead, they should be the catalyst for a worthwhile discussion. After all, we owe it to our veterans to study how some women experience war and homecoming differently, and to determine what can be done to better support female soldiers—women who are now poised, for the first time in history, to be deployed in large numbers in combat positions overseas.

Throughout U.S. history, there has been both an awareness of the effect of war on the human psyche and an effort to protect people from it. As far back as the Revolutionary War, doctors whispered of “soldiers’ heart,” and after World War I, similar symptoms became known as “shell shock.” During much of World War II and into the 1960s, fathers were kept from direct combat, partly out of fear of destroying the family structure back at home, and partly because it was thought that they would not fight if they had too much to come home to. During the war in Vietnam, the exemption for fathers was gradually phased out, but the symptoms of shell shock were so prevalent, it was at last assigned an official name: in 1980, the American Psychological Association (APA) listed PTSD among the mental health disorders, catapulting the abbreviation into the cultural lexicon in books and movies and newspaper headlines.

Unsurprisingly, the majority of those who have suffered in the past century from combat-induced PTSD have been men. While thousands of women served in Vietnam and Korea as nurses, air traffic controllers, support staff, intelligence officers, and other vital positions, they were by and large kept from the front lines. Only eight military women died over the course of the Vietnam War. In 1988, the DOD established what was known as the “risk rule,” in which women were explicitly prohibited from serving in units or missions where the risk of exposure to direct combat, hostile fire, or capture was equal to or greater than the risk in the combat units they supported.

Operation Desert Storm in the early ’90s changed all that. Because of the nature of the engagement, almost everyone deployed—men and women, ambulance drivers and infantry—was physically “at risk.” In response to that changing reality, then Defense Secretary Les Aspin tweaked the risk rule in 1994, opening up all military jobs to women except those below the brigade level where the “primary mission” was to engage in direct combat. The new rule led to an increase in women’s roles in U.S. military operations in Somalia and the Balkans in the ’90s, but it wasn’t until the past decade that female soldiers, in larger numbers than ever before, began to fill roles that put them directly in the line of enemy fire.

Laura Kasinof is a freelance journalist based in Washington, D.C., where she is at work on a book about her three years as a reporter in Yemen. The reporting for this story was generously supported by the Fund for Investigative Journalism.

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